Factors influencing the application of transrectal natural orifice specimen extraction performed laparoscopically for colorectal cancer: A retrospective study.

ABSTRACT

BACKGROUND: A few factors influence the feasibility of transrectal natural orifice specimen extraction (NOSE) surgery for colorectal cancers. However, little is known about the underlying factors of NOSE surgery. METHODS: Consecutive patients with rectal and sigmoid colon cancers treated laparoscopically between January 2014 and April 2017 were enrolled in this study. The transrectal NOSE performed laparoscopically was the first choice of all patients. When NOSE failed, the specimen was removed through a midline abdominal wall incision. Univariate and multivariate logistic regression analyses were performed to identify challenging factors influencing the intraoperative specimen extraction. RESULTS: Overall, 412 consecutive patients were included. NOSE performed laparoscopically was successful in 278 patients (75.5%) and unsuccessful in 90 patients (24.5%). The multivariate analyses indicated that body mass index (BMI; odds ratio [OR] = 3.510, 95% confidence interval [CI] 1.333-9.243, p = 0.011), mesenteric thickness (OR = 1.069, 95% CI 1.032-1.107, p < 0.001), maximum tumor diameter (OR = 2.827, 95% CI 1.094-7.302, p = 0.032), and tumor T stage (OR = 2.831, 95% CI 1.258-6.369, p = 0.012) were the factors influencing the feasibility of NOSE surgery. CONCLUSION: A successful transrectal NOSE surgery was associated with a lower BMI, thinner mesentery, lesser tumor diameter, and earlier tumor T stage.