Robotic natural orifice specimen extraction surgery versus robotic transabdominal specimen extraction surgery for early-stage rectal cancer: a multicenter propensity score-matched analysis (in China)

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发表日期：

2024年6月24日

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Dongning Liu,
Guodong He,
Hongliang Yao,
Xu Guan,
Guiyu Wang,
Dehai Xiong,
Junhong Hu,
Weitang Yuan,
Chunkang Yang,
Penghui He,
Shanping Ye,
Houqiong Ju,
Hongxin Yu,
Zhengchuan Niu,
Kuijie Liu,
Qingchao Tang,
Rui Huang,
Yugui Lian,
Shen Guan,
Jinliang Jian,
Ye Wei,
Xishan Wang,
Taiyuan Li

摘要

Background

Despite the global increase in the adoption of robotic natural orifice specimen extraction surgery (R-NOSES), its advantages over robotic transabdominal specimen extraction surgery (R-TSES) for treating early-stage rectal cancer remain debated. There is scant nationwide, multicenter studies comparing the surgical quality and short-term outcomes between R-NOSES and R-TSES for this condition.

Objective

This retrospective cohort study was conducted nationally across multiple centers to compare the surgical quality and short-term outcomes between R-NOSES and R-TSES in early-stage rectal cancer.

Design

Multicenter retrospective cohort trial.

Setting

Eight experienced surgeons from 8 high-volume Chinese colorectal cancer treatment centers.

Patients

The study included 1086 patients who underwent R-NOSES or R-TSES from October 2015 to November 2023 at the 8 centers. Inclusion criteria were: (1) histologically confirmed rectal adenocarcinoma; (2) robotic total mesorectal excision; (3) postoperative pathological staging of TisN0M0 or T1-2N0M0; (4) availability of complete surgical and postoperative follow-up data. Patients were matched 1:1 in the R-NOSES and R-TSES groups using the propensity score matching (PSM) technique.

Results

After PSM, 318 matched pairs with well-balanced patient characteristics were identified. The operation time for the R-NOSES group was significantly longer than that for the R-TSES group [140 min (125–170 min) vs. 140 min (120–160 min), P = 0.032]. Conversely, the times to first flatus and initial oral intake in the R-NOSES group were significantly shorter than those in the R-TSES group [48 h (41–56 h) vs. 48 h (44–62 h), P = 0.049 and 77 h (72–94 h) vs. 82 h (72–96 h), P = 0.008], respectively. Additionally, the length of postoperative hospital stay was shorter in the R-NOSES group compared with the R-TSES group [7 day (7–9 day) vs. 8 day (7–9 day), P = 0.005]. The overall postoperative complication rates were similar between the groups (10.7% in the R-NOSES group vs. 11.9% in the R-TSES group, P = 0.617). However, the R-NOSES group had a lower incidence of wound complications compared to the R-TSES group (0.0% vs. 2.2%, P = 0.015). Regarding surgical stress response, the R-NOSES group showed superior outcomes. Additionally, patients in the R-NOSES group required fewer additional analgesics on postoperative days 1, 3, and 5 and reported lower pain scores compared to the R-TSES group. The body image scale (BIS) and cosmetic scale (CS) scores were also significantly higher in the R-NOSES group. Furthermore, the R-NOSES group demonstrated significantly better outcomes in functional dimensions such as physical, role, emotional, social, and cognitive functioning, and in symptoms like fatigue and pain, when compared to the R-TSES group.

Limitations

It is imperative to ensure the safe and standardized implementation of R-NOSES through the establishment of a uniform training protocol.

Conclusions

These results affirm that R-NOSES is a safe and effective treatment for early-stage rectal cancer when meticulously executed by skilled surgeons.