AP-NOSES: A Prospective Multicentre Registry of Natural Orifice Specimen Extraction in Minimally Invasive Colorectal Surgery (AP-NOSES)
AP-NOSES: A Prospective, Multicentre Registry of Natural Orifice Specimen Extraction in Minimally Invasive Colorectal Surgery Across the Asia-Pacific Region
Natural orifice specimen extraction (NOSE) is a minimally invasive colorectal surgical technique in which the surgical specimen is removed through a natural orifice, including transanal or transvaginal routes, thereby avoiding an abdominal extraction incision. Observational studies suggest that NOSE may reduce wound-related morbidity and improve postoperative recovery, but prospective multicenter data evaluating long-term outcomes remain limited.
AP-NOSES is a prospective, multicenter observational registry evaluating clinical, patient-reported, and long-term wound outcomes following minimally invasive colorectal surgery with NOSE or transabdominal specimen extraction. The primary objective is to compare time to incisional hernia within 24 months between NOSE-eligible patients undergoing planned NOSE extraction and NOSE-eligible patients undergoing planned transabdominal extraction.
Secondary objectives include evaluation of postoperative complications, extraction-related morbidity, bowel function, urinary and sexual function, oncologic outcomes, and long-term patient-reported and clinical outcomes across participating centers.
This study does not alter routine clinical care. Surgical technique, perioperative management, and follow-up are performed according to local institutional practice.
Přehled studie
Postavení
Podmínky
Detailní popis
Natural orifice specimen extraction (NOSE) is an established minimally invasive colorectal surgical technique that enables removal of the surgical specimen through transanal or transvaginal routes while avoiding an abdominal specimen extraction incision. Existing retrospective studies and meta-analyses suggest that NOSE may reduce postoperative pain, wound morbidity, and length of hospital stay without compromising oncologic outcomes. However, prospective multicenter data evaluating long-term abdominal wall outcomes and patient-reported outcomes remain limited.
Incisional hernia is a common long-term complication following colorectal surgery and is closely associated with the abdominal extraction site. By avoiding an abdominal extraction incision, NOSE may reduce extraction-site morbidity and long-term incisional hernia risk. AP-NOSES was designed to prospectively evaluate these outcomes in a multicenter setting using predefined eligibility criteria and a concurrent comparator cohort.
AP-NOSES is a prospective observational multicenter registry coordinated by Singapore General Hospital. Consecutive adult patients undergoing elective minimally invasive colorectal resection with planned intact specimen extraction are eligible for enrollment. Participating centers include tertiary colorectal units within the Asia-Pacific region.
The primary comparative analysis is conducted within a predefined NOSE-eligible cohort. Exposure groups are defined according to planned specimen extraction strategy:
- Planned NOSE extraction (transanal or transvaginal), and
- Planned transabdominal extraction among patients meeting protocol NOSE eligibility criteria.
Planned and achieved extraction routes, reasons for non-performance of NOSE, operative details, postoperative complications, and oncologic outcomes are prospectively recorded.
The primary outcome is time to incisional hernia within 24 months following index colorectal surgery.
Secondary outcomes include postoperative complications, extraction-site morbidity, surgical site infection, readmission, reoperation, pathologic outcomes, patient-reported quality-of-life and functional outcomes, bowel function, urinary and sexual function in selected patients, and oncologic outcomes including recurrence and disease-free survival.
Patient-reported outcomes are assessed using validated instruments including EQ-5D-5L, Body Image Scale (BIS), Low Anterior Resection Syndrome (LARS) score, International Prostate Symptom Score (IPSS), International Index of Erectile Function-5 (IIEF-5), and Female Sexual Function Index-6 (FSFI-6), where applicable.
This study is observational and does not mandate changes to standard surgical or postoperative management. Data are entered into a secure centralized REDCap database using coded study identifiers.
Typ studie
Zápis (Odhadovaný)
Kontakty a umístění
Studijní kontakt
- Jméno: Isaac Seow-En, MBBS, FRCSEd
- Telefonní číslo: +6563213853
- E-mail: isaac.seow.en@singhealth.com.sg
Studijní místa
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Singapore, Singapur, 169608
- Nábor
- Singapore General Hospital
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Kontakt:
- Isaac Seow-En, MBBS, FRCSEd
- Telefonní číslo: +6563213853
- E-mail: isaac.seow.en@singhealth.com.sg
-
-
Kritéria účasti
Kritéria způsobilosti
Věk způsobilý ke studiu
- Dospělý
- Starší dospělý
Přijímá zdravé dobrovolníky
Metoda odběru vzorků
Studijní populace
Popis
Inclusion Criteria:
- Age 21 years or older
- Elective minimally invasive colorectal resection (laparoscopic or robotic intent)
- Planned intact specimen extraction
- Eligible for natural orifice specimen extraction (NOSE) or transabdominal specimen extraction according to study protocol
- Ability to provide informed consent
Exclusion Criteria:
- Emergency colorectal surgery
- Planned transanal total mesorectal excision (TaTME)
- Planned ultralow anterior resection with planned anastomosis 3 cm or less from the anal verge
- Planned abdominoperineal resection (APR)
- Planned permanent end stoma without restoration of intestinal continuity
- Planned multivisceral resection
- Generalized peritonitis or uncontrolled intra-abdominal sepsis
- Pregnancy
- Pre-existing ventral or incisional hernia at the planned extraction site
- Planned specimen extraction through a prior laparotomy incision containing mesh
- Fixed distal obstruction, severe pelvic stenosis, or other anatomical constraint precluding intact specimen extraction
Studijní plán
Jak je studie koncipována?
Detaily designu
Kohorty a intervence
Skupina / kohorta |
Intervence / Léčba |
|---|---|
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Planned NOSE Extraction
Patients undergoing planned natural orifice specimen extraction (NOSE), including transanal or transvaginal extraction, during elective minimally invasive colorectal surgery.
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Specimen extraction through a natural orifice, including transanal or transvaginal extraction, during minimally invasive colorectal surgery.
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Planned Transabdominal Extraction
NOSE-eligible patients undergoing planned transabdominal specimen extraction during elective minimally invasive colorectal surgery.
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Specimen extraction through an abdominal incision during minimally invasive colorectal surgery.
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Co je měření studie?
Primární výstupní opatření
Měření výsledku |
Popis opatření |
Časové okno |
|---|---|---|
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Time to Incisional Hernia Within 24 Months
Časové okno: 24 months after index surgery
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Time from index colorectal surgery to first clinical or radiologic diagnosis of incisional hernia at or adjacent to the specimen extraction site.
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24 months after index surgery
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Sekundární výstupní opatření
Měření výsledku |
Popis opatření |
Časové okno |
|---|---|---|
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Overall Postoperative Complications
Časové okno: 30 days after surgery
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Postoperative complications within 30 days classified according to the Clavien-Dindo grading system.
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30 days after surgery
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Surgical Site Infection
Časové okno: 30 days after surgery
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Incidence of postoperative surgical site infection following minimally invasive colorectal surgery.
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30 days after surgery
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Extraction-Site Complications
Časové okno: 30 days after surgery
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Extraction-related morbidity including specimen rupture, contamination, bleeding, fistula, or extraction-site injury.
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30 days after surgery
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Length of Hospital Stay
Časové okno: From date of surgery until hospital discharge, up to 30 days
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Length of postoperative inpatient hospital stay following index colorectal surgery.
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From date of surgery until hospital discharge, up to 30 days
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EQ-5D-5L Score
Časové okno: Baseline, 6 months, and 12 months after surgery
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Health-related quality-of-life assessed using the EuroQol 5-Dimension 5-Level (EQ-5D-5L) questionnaire.
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Baseline, 6 months, and 12 months after surgery
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Body Image Scale (BIS) Score
Časové okno: Baseline, 6 months, and 12 months after surgery
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Body image assessed using the Body Image Scale (BIS).
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Baseline, 6 months, and 12 months after surgery
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Low Anterior Resection Syndrome (LARS) Score
Časové okno: 6 months and 12 months after surgery
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Bowel function assessed using the Low Anterior Resection Syndrome (LARS) score.
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6 months and 12 months after surgery
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Local Recurrence
Časové okno: Up to 24 months after surgery
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Incidence of local recurrence following minimally invasive colorectal surgery.
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Up to 24 months after surgery
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Distant Recurrence
Časové okno: Up to 24 months after surgery
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Incidence of distant recurrence following minimally invasive colorectal surgery.
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Up to 24 months after surgery
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Disease-Free Survival
Časové okno: Up to 24 months after surgery
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Time from index colorectal surgery to recurrence or death from any cause.
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Up to 24 months after surgery
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Spolupracovníci a vyšetřovatelé
Sponzor
Publikace a užitečné odkazy
Obecné publikace
- den Hartog FPJ, van Egmond S, Poelman MM, Menon AG, Kleinrensink GJ, Lange JF, Tanis PJ, Deerenberg EB. The incidence of extraction site incisional hernia after minimally invasive colorectal surgery: a systematic review and meta-analysis. Colorectal Dis. 2023 Apr;25(4):586-599. doi: 10.1111/codi.16455. Epub 2023 Jan 5.
- Chin YH, Decruz GM, Ng CH, Tan HQM, Lim F, Foo FJ, Tai CH, Chong CS. Colorectal resection via natural orifice specimen extraction versus conventional laparoscopic extraction: a meta-analysis with meta-regression. Tech Coloproctol. 2021 Jan;25(1):35-48. doi: 10.1007/s10151-020-02330-6. Epub 2020 Aug 26.
- Guan X, Liu Z, Longo A, Cai JC, Tzu-Liang Chen W, Chen LC, Chun HK, Manuel da Costa Pereira J, Efetov S, Escalante R, He QS, Hu JH, Kayaalp C, Kim SH, Khan JS, Kuo LJ, Nishimura A, Nogueira F, Okuda J, Saklani A, Shafik AA, Shen MY, Son JT, Song JM, Sun DH, Uehara K, Wang GY, Wei Y, Xiong ZG, Yao HL, Yu G, Yu SJ, Zhou HT, Lee SH, Tsarkov PV, Fu CG, Wang XS; International Alliance of NOSES. International consensus on natural orifice specimen extraction surgery (NOSES) for colorectal cancer. Gastroenterol Rep (Oxf). 2019 Feb;7(1):24-31. doi: 10.1093/gastro/goy055. Epub 2019 Jan 23.
Termíny studijních záznamů
Hlavní termíny studia
Začátek studia (Aktuální)
Primární dokončení (Odhadovaný)
Dokončení studie (Odhadovaný)
Termíny zápisu do studia
První předloženo
První předloženo, které splnilo kritéria kontroly kvality
První zveřejněno (Aktuální)
Aktualizace studijních záznamů
Poslední zveřejněná aktualizace (Aktuální)
Odeslaná poslední aktualizace, která splnila kritéria kontroly kvality
Naposledy ověřeno
Více informací
Termíny související s touto studií
Klíčová slova
Další relevantní podmínky MeSH
- Pooperační komplikace
- Patologické procesy
- Novotvary podle místa
- Novotvary
- Patologické stavy, anatomické
- Střevní nemoci
- Gastrointestinální novotvary
- Novotvary trávicího systému
- Nemoci trávicího systému
- Gastrointestinální onemocnění
- Střevní novotvary
- Rektální onemocnění
- Onemocnění tlustého střeva
- Kýla
- Patologické stavy, příznaky a symptomy
- Incizní kýla
- Kolorektální novotvary
Další identifikační čísla studie
- 2026-0237
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