1.Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China;2.Department of Colorectal Surgery, the Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
Background and Aims In recent years, natural orifice specimen extraction surgery (NOSES) has been widely carried out in the surgical treatment of early colorectal cancer. The main advantages of this procedure include reducing surgical trauma, accelerating patient recovery, and alleviating adverse psychological implications in patients. However, NOSES is still in the development stage in the treatment of right colon cancer, and many key points of this technique still need to be continuously improved. Therefore, this study was conducted to investigate the feasibility and safety as well as the relevant key issues of NOSES surgery for right colon cancer.Methods The clinical data of a patient who underwent laparoscopic right hemicolectomy (ileocecal junction preservation) and transrectal specimen extraction without abdominal auxiliary incision at the Cancer Hospital Chinese Academy of Medical Sciences were retrospectively analyzed. Combined with the relevant literature reports on NOSES, the key issues such as the scope of bowel resection, the degree of lymph node dissection, the reconstruction method of the digestive tract, and the way of specimen removal in the NOSES operation for right colon cancer were systematically analyzed.Results The case was a 49-year-old male patient who was admitted to the hospital for surgery because of a right-sided colon mass detected by physical examination. The preoperative clinical stage was cT2N0M0. The surgical procedures mainly included dissociation of the right colon, ligation of the right colic artery and vein and dissection of regional lymph nodes; division of the colon at appropriately 10 cm from the proximal end of the tumor after dissection of the mesentery, and division of the ascending colon at 5 cm distal to the entrance of the ileocecal valve after complete shaving of the mesentery, and side-to-side anastomosis between the ascending and transverse colons; incision of the rectum at 5 cm above the peritoneal reflection, and transanal extraction of the specimen; closure of the rectal incision with a barbed suture followed by reinforcement of the seromuscular layer. The postoperative pathological stage was pT2N0. The patient showed first bowel movement at postoperative day (POD) 1, had liquid food intake at POD 2, and was discharged from the hospital at POD 5. Literature review of 10 previous articles indicated that in NOSES compared with conventional laparoscopic surgery, the incidence of postoperative complications did not increase but was even somewhat reduced, and offered better minimally invasive results in terms of postoperative recovery, while showed no obvious differences in other surgical variables.Conclusion This case of NOSES with ileocecal junction preservation for right colon cancer demonstrates the combination of minimal invasiveness, functional preservation and meticulous operation. However, this procedure also has specific technical difficulties, so comprehensive preoperative assessment and close cooperation are necessary to ensure the successful implementation of the process. In the future, more high-quality clinical studies are needed to provide evidence-based information to systemically evaluate its short-term and long-term efficacy.
GUAN Xu, JIAO Shuai, CHEN Haipeng, ZHENG Zhaoxu, WANG Xishan. Laparoscopic right colon cancer resection by transrectal specimen extraction without abdominal auxiliary incision (ileocecal junction preservation): a case report and literature review[J]. Chin J Gen Surg,2022,31(11):1510-1517.