Totally laparoscopic resection with natural orifice specimen extraction (NOSE) has more advantages comparing with laparoscopic-assisted resection for selected patients with sigmoid colon or rectal cancer

The purposes of this study were to compare the short-term outcomes of natural orifice specimen extraction (NOSE) and laparoscopic-assisted resection for sigmoid colon cancer or rectal cancer and to appraise whether totally laparoscopic resection with NOSE had more advantages compared with conventional laparoscopic-assisted resection. Sixty-five patients who underwent totally laparoscopic resection with NOSE were assigned to NOSE group, and 132 patients who underwent laparoscopic-assisted resection were assigned to laparoscopic-assisted (LA) group. Data of all 197 cases were reviewed. Short-term outcomes (including operative outcomes, gastrointestinal recovery, hospital stay, and complication) of the two groups were compared. Mean numbers of lymph nodes harvested were 17.0 +/- 8.3 and 18.9 +/- 11.6 in NOSE group and LA group, respectively, (P = 0.248); mean operative times were 111.6 +/- 25.4 min and 115.3 +/- 23.0 min in the two groups (P = 0.384); and the mean blood losses in these two groups were 70.2 +/- 66.1 ml and 126.3 +/- 58.6 ml, respectively, (P < 0.001). Times to first flatus were 2.7 +/- 0.8 and 3.4 +/- 0.9 days (P < 0.001), and times to first defecation were 3.3 +/- 0.6 and 3.9 +/- 1.1 days (P = 0.002) in NOSE group and LA group, respectively. Hospital stay in NOSE group were 9.0 +/- 1.9 and 9.9 +/- 2.0 days in LA group. Incidences of peri-operative complications were 6.2 and 17.2 % in the two groups, respectively (P = 0.031). Without compromising oncologic outcome, totally laparoscopic resection with NOSE had more advantages including less blood loss, less pain, faster recovery of intestinal function and shorter hospital stay compared with laparoscopic-assisted resection for selected patients with sigmoid colon cancer or rectal cancer.