Safety and Survival Outcomes of Transanal Natural Orifice Specimen Extraction Using Prolapsing Technique for Patients with Middle- to Low-rectal Cancer

Objective: The transanal approach to specimen collection, combined with the prolapsing technique, is a well-established and minimally invasive surgery for treating rectal cancer. However, reports on outcomes for this approach are sparse. We compared short- and long-term outcomes of conventional laparoscopic surgery (CLS) transanal natural orifice specimen extraction (NOSE) using the prolapsing technique for patients with middle- to low-rectal cancer.

Methods: From January 2013 to December 2017, we enrolled consecutive patients with middle- to low-rectal cancer undergoing laparoscopic anterior resection. Totally, 50 patients who underwent transanal NOSE using the prolapsing technique were matched with 50 patients who received CLS. Clinical parameters and survival outcomes between the two groups were compared.

Results: Estimated blood loss (29.70±29.28 . 52.80±45.09 mL, P=0.003), time to first flatus (2.50±0.79 . 2.86±0.76, P=0.022), time to liquid diet (3.62±0.64 . 4.20±0.76 d, P<0.001), and the need for analgesics (22%. 48%, P=0.006) were significantly lower for the NOSE group compared to the CLS group. The incidences of overall complications and fecal incontinence were comparable in both groups. After a median follow-up of 44.52 months, the overall local recurrence rate (6% . 5%, P=0.670), 3-year disease-free survival (86.7% . 88.0%, P=0.945) and 3-year overall survival (95.6% . 96.0%, P=0.708), were not significantly different.

Conclusions: For total laparoscopic rectal resection, transanal NOSE using the prolapsing technique is effective and safe, and associated with less trauma and pain, a faster recovery, and similar survival outcomes compared to CLS.