Natural orifice specimen extraction surgery in left-sided colon and upper rectal cancer: a narrative review

Abstract

Background and Objective: Natural orifice specimen extraction surgery (NOSES) is an innovative technique, used in minimally invasive surgery for colorectal cancer. NOSES has been demonstrated as a safe and effective method in patients matching the inclusion criteria. Objective was to analyze and review articles regarding short- and long-term outcomes in NOSES in left-sided colon and upper rectal cancer. Methods: We conducted a search in PubMed and Cochrane Reviews databases and reviewed the studies in English regarding NOSES in left-sided colon and upper rectal cancer published until May 2022. Key Content and Findings: This literature review contains short summary of the recent articles’ results regarding NOSES in left-sided and upper rectal colon cancer. Studies showed better short-term outcomes and comparable with conventional laparoscopy long-term outcomes. Pitfalls and challenges of NOSES-studies include implementing standardized research protocols and thoughtful recruitment of patients due to the necessity of getting accurate and reproducible results. Conclusions: The advantages of NOSES in colorectal cancer treatment including reduction in postoperative pain and wound complications, less use of postoperative analgesics, faster recovery of bowel function have been described in left-sided colon and upper rectal cancer treatment. Oncological outcomes do not differ with conventional laparoscopic surgery with specimen extraction via laparotomy. is LCCS patients the best treatment results. Natural orifice specimen extraction 95% 0.59 to 1.25; I = 0%; P=0.43]. Two studies provided data on the 5-year OS rate. There was no significant difference in 5-year OS between NOSES and conventional laparoscopy groups (HR = 0.78; 95% CI: 0.43 to 1.40; I 2 =0%; P=0.40) (16).