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Abstract：
Background, Natural orifice specimen extraction (NOSE) via the anus or vagina is an alternative to conventional transabdominal specimen extraction in laparoscopic colorectal cancer surgery. NOSE has been shown to be safe and effective, resulting in decreased postoperative pain, analgesia use, and improved recovery, without oncological compromise. We aimed to demonstrate the feasibility of NOSE for combined colectomy with liver metastasectomy. Methods, From July 2022 to April 2024, all cases of laparoscopic colorectal cancer resection and synchronous liver metastasectomy with NOSE were included in the study. Selection criteria included a maximum specimen diameter of less than 5 cm and patient body mass index of less than 35 kg/m2. Results, Over the 22-month duration, four consecutive patients (two males, two females) underwent combined resection with NOSE. Mean age and BMI were 74.8 (range 63-81) years and 20.9 (range 19.5-22.3) kg/m2 respectively. Patient A and D underwent anterior resection for sigmoid cancer, Patient B underwent D3 right hemicolectomy for cecal cancer, and Patient C underwent subtotal colectomy for synchronous cecal and descending colon cancer. All patients underwent liver metastasectomy at the same sitting. Patient A and D had transanal NOSE while Patients B and C underwent transvaginal NOSE. Mean operative time and blood loss was 416 (range 330-535) minutes and 338 (range 50-500) ml respectively. All patients recovered gastrointestinal function within the first two postoperative days. Infected seroma of the liver bed occurred in one patient requiring percutaneous drainage. The average maximum colon tumor diameter was 2.9 (range 1.3-4.0) cm. All resection margins were clear. Mean duration of follow-up was 7.5 (range 2-12) months. Conclusions, Simultaneous colectomy and liver metastasectomy with NOSE for colorectal cancer is feasible and safe in highly selected patients, resulting in good postoperative outcomes. This proof-of-concept analysis paves the way for larger studies to draw definitive conclusions.
摘要：
背景,通过肛门或阴道进行自然孔口标本提取（NOSE）是腹腔镜结直肠癌手术中常规经腹标本提取的替代方法。NOSE被证明是安全有效的，导致术后疼痛减少，镇痛使用，和改善恢复，没有肿瘤妥协。我们旨在证明NOSE用于联合结肠切除术和肝转移切除术的可行性。Methods,2022年7月至2024年4月，所有腹腔镜结直肠癌切除术和NOSE同步肝转移切除术病例均纳入研究。选择标准包括小于5cm的最大样本直径和小于35kg/m2的患者体重指数。Results,在22个月的时间里，四名连续患者(两名男性，两名女性）接受了NOSE联合切除。平均年龄和BMI分别为74.8（63-81）岁和20.9（19.5-22.3）kg/m2。患者A和D接受了乙状结肠癌的前切除术，患者B因盲肠癌接受D3右半结肠切除术，和C患者接受了结肠次全切除术，用于同步盲肠和降结肠癌。所有患者均在同一坐位进行肝转移切除术。患者A和D经肛门鼻，而患者B和C经阴道鼻。平均手术时间和失血量分别为416（330-535）分钟和338（50-500）ml。所有患者在术后前2天内胃肠功能恢复。一名需要经皮引流的患者发生肝床感染血清瘤。平均最大结肠肿瘤直径为2.9（范围1.3-4.0）cm。所有切除边缘清晰。平均随访时间为7.5个月（范围2-12个月）。Conclusions,同时行结肠切除术和肝转移瘤切除加NOSE治疗结直肠癌在高度选择的患者中是可行和安全的。导致良好的术后结果。这种概念验证分析为更大的研究得出明确的结论铺平了道路。
