Ressecção laparoscópica do câncer colorretal com extração de espécime em orifício natural: um estudo prospectivo

Islam H. Metwally ^**Corresponding author. E-mail: drislamhany@mans.edu.eg (I.H. Metwally).

Oncology Center Mansoura University (OCMU), Surgical Oncology Unit, Mansoura, Dakahlia, Egypt

Sherif Z. Kotb

Oncology Center Mansoura University (OCMU), Surgical Oncology Unit, Mansoura, Dakahlia, Egypt

Mohamed A.F. Hegazy

Oncology Center Mansoura University (OCMU), Surgical Oncology Unit, Mansoura, Dakahlia, Egypt

Waleed Elnahas

Oncology Center Mansoura University (OCMU), Surgical Oncology Unit, Mansoura, Dakahlia, Egypt

José F. Noguera

Complejo Hospital Universitario A Coruña (CHUAC), Servicio de Cirugía General y Digestiva, La Coruña, Galicia, Spain

Conflicts of interest

The authors declare no conflicts of interest.

JFN reports personal fees from Medtronic, other from Johnson & Johnson, outside the submitted work.

Operative details	Patients
Conversion rate	3 cases were supplemented by Pfannenstiel incision while 1 was complemented by a midline incision.
Specimen extraction	Transanal/transrectal route in 13 cases and transvaginal in 3 cases.
Anastomosis	10 hand-sewn, 3 double stapling, 1 triple stapling, 1 single stapling and with 1 no anastomosis.
Anastomosis	In 14 cases the anastomosis was end to end, while in 1 patient after a right hemicolectomy a side-to-side anastomosis was done.
Operative time	The mean operative time was 297 min (SD = 94 min).
Blood loss	The median blood loss was 300 mL (with range 700 mL).
Intraoperative blood transfusion	5 cases received transfusion (1-2 packs).
Ostomy	In 7 cases no stoma, while in 6 patients an ileostomy, in 2 cases transverse colostomy and in 1 Hartmann's colostomy.

Complication	Clavien-Dindo	Treatment
2 Pulmonary embolism	IVa	Both survived on conservative measures
4 Anastomotic stenosis	IIIb	3 ended by permanent stoma and 1 treated by resection anastomosis
1 Partial disruption of coloanal anastomosis	IIIb	Transanal debridement and refashioning
1 Major bleeding	IIIb	Exploration
1 Intestinal obstruction	IIIb	Exploration and resection anastomosis of jejunal volvulus
1 Minor leak and perirectal abscess	IIIa	Transanal drainage and antibiotics
1 Urine retention	I	Urine catheter
4 Wound infections	I	Antibiotics

Parameter	Natural orifice extraction (NOSE)		p-value
	Succeeded (12 cases)	Failed (4 cases)
Age	Mean 48.09 (SD = 10.88)	Mean 65.5 (SD = 8.35)	0.013
BMI	Mean 28.05 (SD = 5.07)	Mean 27.3 (SD = 4.84)	0.838
Site	8 low rectum, 2 mid-rectum, 1 sigmoid and 1 ascending	4 sigmoid	0.008
Size	Mean 3.77 (SD = 1.62)	Mean 3.62 (SD = 2.72)	0.904
Distance from anal verge	Median 5 (range 2-25)	Median 15 (range 15-25)	0.27

A
Parameter	Natural orifice extraction (NOSE)		p-value
	Succeeded (12 cases)	Failed (4 cases)
Operative time	Mean 277 (SD = 93)	Mean 285 (SD = 110)	0.509
Hospital stay	Median 8.5 (range 6-45)	Median 7.5 (range 5-12)	1
Oral intake	Median 3.5 (range 1-7)	Median 1 (range 1-5)	0.559
Blood loss	Median 300 (range 150-750)	Median 375 (range 50-650)	0.810
LN retrieved	Median 10 (range 1-26)	Median 11 (range 4-14)	0.792
Wound infection	2 cases	2 cases	0.248
Other complications	7 cases	1 case	0.182
B
Parameter	Natural orifice extraction (NOSE)		p-value
	Succeeded (5 cases)	Failed (4 cases)
Operative time	Mean 269 (SD = 145)	Mean 285 (SD = 111)	0.86
Hospital stay	Mean 6.8 (SD = 1.3)	Mean 8 (SD = 3.6)	0.56
Oral intake	Median 2 (range 1-5)	Median 1 (range 1-5)	0.6
Blood loss	Median 300 (range 150-300)	Median 375 (range 50-650)	0.97
LN retrieved	Mean 18.6 (SD = 9.3)	Mean 10 (SD = 4.2)	0.135
Wound infection	Not encountered	2 cases	0.073
Other complications	2 cases	1 case	0.635

Brasil