Propensity score-matched comparison between totally laparoscopic right hemicolectomy with transcolonic natural orifice specimen extraction and conventional laparoscopic surgery with mini-laparotomy in the treatment of ascending colon cancer (with video).

BACKGROUND AND AIMS: Now that the debate about the safety and effectiveness of laparoscopic versus open surgery is over, attention has turned to innovations that can verify whether minimizing the impact of laparoscopy on the abdominal wall can further reduce pain, improve patient comfort, lead to superior cosmesis, and reduce morbidity. The aim of this study was to further explore the application value of totally laparoscopic right hemicolectomy with transcolonic natural orifice specimen extraction (NOSE) and to evaluate the short-term efficacy of transcolonic NOSE surgery for resecting specimens of ascending colon cancer.

METHODS: From January 2016 to May 2017, a retrospective study was conducted in Guangxi. Propensity score matching was used to minimize the bias from nonrandomized treatment assignment. Patients were followed up through May 2020.

RESULTS: Forty-nine patients underwent totally laparoscopic right hemicolectomy with transcolonic NOSE, and 116 patients underwent laparoscopic right hemicolectomy with mini-laparotomy (ML) procedures at our institution. After propensity score matching, each group included 45 patients, and all the covariate imbalances were alleviated. The transcolonic NOSE group and the ML group did not differ significantly in terms of baseline clinical characteristics. The transcolonic NOSE group was associated with a shorter time to first flatus (NOSE 1.8 ± 0.5 vs ML 3.2 ± 0.8, p=0.032), a shorter length of hospital stay (NOSE 11.3 ± 2.5 days vs ML 13.0 ± 3.1 days, p=0.034), a shorter time to first liquid intake (NOSE 2.6 ± 0.8 vs ML 3.8 ± 0.9, p=0.068), less pain (NOSE 1.8 ± 0.8 vs ML 4.2 ± 0.7, p=0.013), less analgesia requirement (NOSE 6 (13.3%) vs ML 21 (46.7%), p=0.001), lower CRP levels on POD1 (NOSE 3.6 ± 1.7 vs ML 8.2 ± 2.2, p=0.001) and POD3 (NOSE 2.4 ± 1.4 vs ML 4.6 ± 1.7, p=1.7 vs ML 8.2 ± 2.2, p=0.001) than the POSE group. The median follow-up was 28.4 months (interquartile range, 18.0-36.0 months). The 3-year overall survival rates were similar between the transcolonic NOSE group and the ML group.

CONCLUSION: In total, laparoscopic right hemicolectomy with transcolonic specimen extraction appears to be safe for selected patients with ascending colon cancer as a minimally invasive surgery.