Natural orifice transluminal endoscopic surgery for colorectal cancer. Issue 1 (24th May 2017)

• Record Type: Journal Article
• Authors: Hiep, P N; Thien, H H; Vu, P A; Thanh, P H; Xuan, N T
• Is Part Of: BJS open. Volume 1:Issue 1(2017)
• Page Start: 24
• Page End: 29
• Publication Date: 2017-05-24
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1002/bjs5.4
• Languages: English
• ISSNs: 2474-9842

Abstract

Abstract: Background: Natural orifice transluminal endoscopic surgery (NOTES) has theoretical advantages over other approaches. Methods: This was a prospective cohort study of colorectal cancers operated on by NOTES (transanally for rectal tumours, transvaginally for sigmoid tumours) between December 2013 and December 2015, with a minimum follow-up of 1 year. Eligibility criteria included ASA fitness grade I–III, BMI below 25 kg/m 2 and TNM stage T3 N0 M0. Exclusion criteria included pregnancy or distant metastasis. The anastomosis was either handsewn or performed mechanically. Results: Sixteen patients were operated on by a transanal and four by a transvaginal approach. There were ten men and ten women, with a mean(s.d.) age of 55·6(12·1) years. Mean BMI was 22·4(2·6) kg/m 2 . Four anterior, 11 low anterior and five intersphincteric resections were performed for 16 rectal and four low sigmoid tumours. The mean duration of surgery was 258(11) min. No conversion to laparotomy was needed, and there were no deaths. Five patients required additional ports, for intraoperative bleeding (1), suture of an intraoperative urethral injury with covering ileostomy (1) and difficulty in dissection (3). One patient had an anastomotic leak requiring transanal closure and ileostomy on day 7. Both ileostomies were closed after 2 months. The mean hospital stay was 6·4(1·8) days. All resections were R0. Conclusion: In carefully selected patients NOTES for colorectal cancer resection was feasible and effective. Graphical Abstract: Natural orifice transluminal endoscopic surgery (NOTES) has several advantages but is challenging for colorectal surgeons. The results of a prospective study of 20 patients undergoing rectal or sigmoid resection via a NOTES technique showed it was feasible and effective. However, multicentre studies with larger series and longer follow-up to evaluate surgical as well as oncological outcomes are necessary. Needs further assessment in the West