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AP-NOSES: A Prospective Multicentre Registry of Natural Orifice Specimen Extraction in Minimally Invasive Colorectal Surgery (AP-NOSES)

22 mai 2026 mis à jour par: Isaac Seow En, Singapore General Hospital

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.

Aperçu de l'étude

Statut

Recrutement

Les conditions

Intervention / Traitement

Description détaillée

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:

  1. Planned NOSE extraction (transanal or transvaginal), and
  2. 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.

Type d'étude

Observationnel

Inscription (Estimé)

800

Contacts et emplacements

Cette section fournit les coordonnées de ceux qui mènent l'étude et des informations sur le lieu où cette étude est menée.

Coordonnées de l'étude

Lieux d'étude

Critères de participation

Les chercheurs recherchent des personnes qui correspondent à une certaine description, appelée critères d'éligibilité. Certains exemples de ces critères sont l'état de santé général d'une personne ou des traitements antérieurs.

Critère d'éligibilité

Âges éligibles pour étudier

  • Adulte
  • Adulte plus âgé

Accepte les volontaires sains

Non

Méthode d'échantillonnage

Échantillon non probabiliste

Population étudiée

Adult patients undergoing elective minimally invasive colorectal resection with planned intact specimen extraction at participating tertiary colorectal centers in the Asia-Pacific region.

La description

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

Plan d'étude

Cette section fournit des détails sur le plan d'étude, y compris la façon dont l'étude est conçue et ce que l'étude mesure.

Comment l'étude est-elle conçue ?

Détails de conception

Cohortes et interventions

Groupe / Cohorte
Intervention / Traitement
Planned NOSE Extraction
Patients undergoing planned natural orifice specimen extraction (NOSE), including transanal or transvaginal extraction, during elective minimally invasive colorectal surgery.
Procédure: Natural Orifice Specimen Extraction
Specimen extraction through a natural orifice, including transanal or transvaginal extraction, during minimally invasive colorectal surgery.
Planned Transabdominal Extraction
NOSE-eligible patients undergoing planned transabdominal specimen extraction during elective minimally invasive colorectal surgery.
Procédure: Transabdominal Specimen Extraction
Specimen extraction through an abdominal incision during minimally invasive colorectal surgery.

Que mesure l'étude ?

Principaux critères de jugement

Mesure des résultats
Description de la mesure
Délai
Time to Incisional Hernia Within 24 Months
Délai: 24 months after index surgery
Time from index colorectal surgery to first clinical or radiologic diagnosis of incisional hernia at or adjacent to the specimen extraction site.
24 months after index surgery

Mesures de résultats secondaires

Mesure des résultats
Description de la mesure
Délai
Overall Postoperative Complications
Délai: 30 days after surgery
Postoperative complications within 30 days classified according to the Clavien-Dindo grading system.
30 days after surgery
Surgical Site Infection
Délai: 30 days after surgery
Incidence of postoperative surgical site infection following minimally invasive colorectal surgery.
30 days after surgery
Extraction-Site Complications
Délai: 30 days after surgery
Extraction-related morbidity including specimen rupture, contamination, bleeding, fistula, or extraction-site injury.
30 days after surgery
Length of Hospital Stay
Délai: From date of surgery until hospital discharge, up to 30 days
Length of postoperative inpatient hospital stay following index colorectal surgery.
From date of surgery until hospital discharge, up to 30 days
EQ-5D-5L Score
Délai: Baseline, 6 months, and 12 months after surgery
Health-related quality-of-life assessed using the EuroQol 5-Dimension 5-Level (EQ-5D-5L) questionnaire.
Baseline, 6 months, and 12 months after surgery
Body Image Scale (BIS) Score
Délai: Baseline, 6 months, and 12 months after surgery
Body image assessed using the Body Image Scale (BIS).
Baseline, 6 months, and 12 months after surgery
Low Anterior Resection Syndrome (LARS) Score
Délai: 6 months and 12 months after surgery
Bowel function assessed using the Low Anterior Resection Syndrome (LARS) score.
6 months and 12 months after surgery
Local Recurrence
Délai: Up to 24 months after surgery
Incidence of local recurrence following minimally invasive colorectal surgery.
Up to 24 months after surgery
Distant Recurrence
Délai: Up to 24 months after surgery
Incidence of distant recurrence following minimally invasive colorectal surgery.
Up to 24 months after surgery
Disease-Free Survival
Délai: Up to 24 months after surgery
Time from index colorectal surgery to recurrence or death from any cause.
Up to 24 months after surgery

Collaborateurs et enquêteurs

C'est ici que vous trouverez les personnes et les organisations impliquées dans cette étude.

Parrainer

Singapore General Hospital

Publications et liens utiles

La personne responsable de la saisie des informations sur l'étude fournit volontairement ces publications. Il peut s'agir de tout ce qui concerne l'étude.

Publications générales

Dates d'enregistrement des études

Ces dates suivent la progression des dossiers d'étude et des soumissions de résultats sommaires à ClinicalTrials.gov. Les dossiers d'étude et les résultats rapportés sont examinés par la Bibliothèque nationale de médecine (NLM) pour s'assurer qu'ils répondent à des normes de contrôle de qualité spécifiques avant d'être publiés sur le site Web public.

Dates principales de l'étude

Début de l'étude (Réel)

5 mai 2026

Achèvement primaire (Estimé)

30 mars 2033

Achèvement de l'étude (Estimé)

30 décembre 2033

Dates d'inscription aux études

Première soumission

19 mai 2026

Première soumission répondant aux critères de contrôle qualité

22 mai 2026

Première publication (Réel)

29 mai 2026

Mises à jour des dossiers d'étude

Dernière mise à jour publiée (Réel)

29 mai 2026

Dernière mise à jour soumise répondant aux critères de contrôle qualité

22 mai 2026

Dernière vérification

1 mai 2026

Plus d'information

Termes liés à cette étude

Mots clés

Termes MeSH pertinents supplémentaires

Autres numéros d'identification d'étude

  • 2026-0237

Plan pour les données individuelles des participants (IPD)

Prévoyez-vous de partager les données individuelles des participants (DPI) ?

INDÉCIS

Description du régime IPD

Individual participant data sharing plans have not yet been finalized. Future sharing of deidentified data may be considered following establishment of multicenter governance, data-sharing agreements, and publication policies.

Informations sur les médicaments et les dispositifs, documents d'étude

Étudie un produit pharmaceutique réglementé par la FDA américaine

Non

Étudie un produit d'appareil réglementé par la FDA américaine

Non

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