Laparoscopic High Anterior Resection with Transrectal Natural Orifice Specimen Extraction Has Better Short-Term Recovery and Psychological Wellness Outcomes Compared to Conventional Laparoscopy

Abstract

\n Background: Transrectal natural orifice specimen extraction (NOSE) is less invasive compare to traditional laparoscopic-assisted anterior resection (LAR). However, psychological evaluation of patients after transrectal LAR-NOSE is needed to evaluate its clinical feasibility. This study aimed to compare patient outcomes between LAR and LAR-NOSE.Methods: We studied 215 patients with colorectal cancer who underwent surgery between June 2015 and April 2018; they were randomized into two groups: LAR-NOSE (n=109) and LAR (n=106). Data on pain, anxiety, and depression were collected and compared. Pain was assessed by a visual analogue scale (VAS) and anxiety and depression by the self-rating anxiety scale (SAS), self-rating depression scale (SDS), and state-trait anxiety inventory. The overall survival and 5-year disease-free survival (DFS) rates were noted.Results: The extraction success rate in the LAR-NOSE group was 87.1% (95/109 cases). The LAR-NOSE SAS (44.21 ± 8.46) and SDS (37.29 ± 8.98) scores were significantly lower than the LAR scores (51.04 ± 9.12 and 44.65 ± 9.27, respectively; P<0.05) 1 week postoperatively. The LAR VAS scores were significantly higher on postoperative days 1–3 (P<0.05). LAR-NOSE was associated with faster operational and intestinal recovery times, less blood loss, and shorter postoperative hospitalization (P<0.05). However, 5-year DFS between the groups was the same.Conclusion: patients in the LAR-NOSE group showed better outcomes related to postoperative anxiety and depression, postoperative complications, and short-term postoperative recovery. Our results suggest transrectal NOSE as a feasible and potentially preferable method for treatment in selected patients.Registration No: SHDFYY2015-098 Date:2015.02.01