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Laparoscopic resection with natural orifice specimen extraction versus conventional laparoscopy for colorectal disease: a meta-analysis

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

We wished to determine the effects of laparoscopic resection using natural orifice specimen extraction (NOSE) for patients with colorectal disease through a meta-analysis.

Methods

A study search was undertaken in PubMed, EMBASE, and Cochrane databases for eligible studies until December 2014. Duration of hospital stay, operation time, time to first flatus, pain score, cosmetic result, postoperative complications, and disease-free survival (DFS) were the main endpoints. The results were analyzed using RevMan v5.3.

Results

Nine clinical studies involving 837 patients were included for final analyses. Laparoscopic resection with NOSE had a shorter duration of hospital stay (weighted mean difference (WMD) = −0.62 days, 95 % confidence interval (CI) [−0.95, −0.28], p < 0.01) and time to first flatus (WMD = −0.59 days, 95 % CI [−0.78, −0.41], p < 0.01), less postoperative pain (WMD = −1.43, 95 % CI [−1.95, −0.90], p < 0.01), and postoperative complications (odds ratio (OR) = 0.51, 95 % CI [0.36, 0.74], p < 0.01) with better cosmetic result (WMD = 1.37, 95 % CI [0.59, 2.14], p < 0.01). However, the operation time was significantly longer in the NOSE group (WMD = 20.97 min, 95 % CI [4.33, 37.62], p = 0.01). No significant difference was observed in DFS (hazard ratio (HR) = 0.88, 95 % CI [0.49, 1.57], p = 0.67).

Conclusion

Our meta-analysis supported the notion that laparoscopic resection with NOSE for colorectal disease can significantly reduce the duration of hospital stay, accelerate postoperative recovery with better cosmetic results, and in particular, result in less postoperative pain and fewer complications.

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Acknowledgments

We thank the department of Surgical Oncology of First Hospital of China Medical University and the College of China Medical University for technical assistance in this analysis. This work was supported by the National Science Foundation of China (No. 81201888, No. 81372549, and No. 81172370) and Ministry of Education (IRT13101).

Conflict of interest

The sponsors had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding author had full access to all the data and analyses. Bin Ma, Xuanzhang Huang, Peng Gao, Junhua Zhao, Yongxi Song, Jingxu Sun, Xiaowan Chen, and Zhenning Wang declare that they have no conflicts of interest, and all authors approve the final decision to submit for publication.

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    Authors and Affiliations

    1. Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University, Shenyang, 110001, People’s Republic of China

      Bin Ma, Xuan-zhang Huang, Peng Gao, Jun-hua Zhao, Yong-xi Song, Jing-xu Sun, Xiao-wan Chen & Zhen-ning Wang

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    1. Bin Ma
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    Correspondence to Zhen-ning Wang.

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    Bin Ma and Xuan-zhang Huang contributed equally to this work.

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    Ma, B., Huang, Xz., Gao, P. et al. Laparoscopic resection with natural orifice specimen extraction versus conventional laparoscopy for colorectal disease: a meta-analysis. Int J Colorectal Dis 30, 1479–1488 (2015). https://doi.org/10.1007/s00384-015-2337-0

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