International consensus on natural orifice specimen extraction surgery (NOSES) for colorectal cancer

Xu Guan, Zheng Liu, Antonio Longo, Jian-Chun Cai, William Tzu-Liang Chen, Lu-Chuan Chen, Ho-Kyung Chun, Joaquim Manuel da Costa Pereira, Sergey Efetov, Ricardo Escalante, Qing-Si He, Jun-Hong Hu, Cuneyt Kayaalp, Seon-Hahn Kim, Jim S Khan, Li-Jen Kuo, Atsushi Nishimura, Fernanda Nogueira, Junji Okuda, Avanish Saklani, Ali A Shafik, Ming-Yin Shen, Jung-Tack Son, Jun-Min Song, Dong-Hui Sun, Keisuke Uehara, Gui-Yu Wang, Ye Wei, Zhi-Guo Xiong, Hong-Liang Yao, Gang Yu, Shao-Jun Yu, Hai-Tao Zhou, Suk-Hwan Lee, Petr V Tsarkov, Chuan-Gang Fu, Xi-Shan Wang, International Alliance of NOSES, Xu Guan, Zheng Liu, Antonio Longo, Jian-Chun Cai, William Tzu-Liang Chen, Lu-Chuan Chen, Ho-Kyung Chun, Joaquim Manuel da Costa Pereira, Sergey Efetov, Ricardo Escalante, Qing-Si He, Jun-Hong Hu, Cuneyt Kayaalp, Seon-Hahn Kim, Jim S Khan, Li-Jen Kuo, Atsushi Nishimura, Fernanda Nogueira, Junji Okuda, Avanish Saklani, Ali A Shafik, Ming-Yin Shen, Jung-Tack Son, Jun-Min Song, Dong-Hui Sun, Keisuke Uehara, Gui-Yu Wang, Ye Wei, Zhi-Guo Xiong, Hong-Liang Yao, Gang Yu, Shao-Jun Yu, Hai-Tao Zhou, Suk-Hwan Lee, Petr V Tsarkov, Chuan-Gang Fu, Xi-Shan Wang, International Alliance of NOSES

Abstract

In recent years, natural orifice specimen extraction surgery (NOSES) in the treatment of colorectal cancer has attracted widespread attention. The potential benefits of NOSES including reduction in postoperative pain and wound complications, less use of postoperative analgesic, faster recovery of bowel function, shorter length of hospital stay, better cosmetic and psychological effect have been described in colorectal surgery. Despite significant decrease in surgical trauma of NOSES have been observed, the potential pitfalls of this technique have been demonstrated. Particularly, several issues including bacteriological concerns, oncological outcomes and patient selection are raised with this new technique. Therefore, it is urgent and necessary to reach a consensus as an industry guideline to standardize the implementation of NOSES in colorectal surgery. After three rounds of discussion by all members of the International Alliance of NOSES, the consensus is finally completed, which is also of great significance to the long-term progress of NOSES worldwide.

Keywords: colorectal cancer; laparoscopy; natural orifice specimen extraction surgery (NOSES); natural orifice transluminal endoscopic surgery (NOTES); transanal total mesorectal excision (TaTME).

Figures

Figure 1.
Figure 1.
Transanal specimen eversion and extra-abdominal resection technique. (A) The anvil is introduced into the bowel lumen of rectum till to the proposed resection line of sigmoid colon. (B) Proximal bowel division is performed using linear stapler, leaving the anvil inside of sigmoid colon. (C) The rectal stump is everted out transanally. (D) The distal rectal resection is performed extraabdominally. (E) The rectal stump is delivered back to pelvic cavity. (F) The circular stapler is introduced transanally and an end-to-end anastomosis is performed
Figure 2.
Figure 2.
Translumenal specimen extraction and extra-abdominal resection technique. (A) The rectal wall is cut off at the distal resection line. (B) The distal side of specimen is gently pulled outside of the patient body transanally. (C) The proximal rectal resection is performed extraabdominally. (D) The anvil is introduced into the bowel lumen and closed with a purse string, and the sigmoid colon is delivered back to pelvic cavity. (E) The open rectal stump is closed by using linear stapler. (F) The circular stapling device is introduced into the rectum, and an end-to-end anastomosis is performed
Figure 3.
Figure 3.
Intra-abdominal specimen resection and translumenal extraction technique. (A) The anvil is introduced into the bowel lumen of rectum till to the proposed resection line of sigmoid colon. (B) The proximal bowel division is performed using linear stapler, leaving the anvil inside of sigmoid colon. (C) The rectal wall is cut off at the distal resection line. (D) The specimen is extracted through the anus. (E) The open rectal stump is closed with a linear stapler. (F) The circular stapling device is introduced into the rectum, and an end-to-end anastomosis is performed
Figure 4.
Figure 4.
The flow chart for the selection of natural orifice specimen extraction surgery (NOSES). BMI: body mass index; CDmax: maximum circumferential diameter ① If pathologic examination shows pT2 or pT1 with high-risk features including positive margins, lymphovascular invasion, poor differentiation or invasion into the lower third of the submucosa (sm3 level), a more radical transabdominal resection is recommended. ② If extensive adhesions are detected in the abdominal cavity, tumor is detected in locally advanced stage or an uncontrollable complication occurs during surgery, the laparoscopic surgery should be converted to open surgery. ③ For male patient, if the specimen cannot be extracted transanally, transabdominal specimen extraction should be performed. ④ For female patient, if the specimen cannot be extracted transanally, transvaginal specimen extraction should be performed. ⑤ For female patient, if the specimen cannot be extracted transvaginally, transabdominal specimen extraction should be performed.

References

    1. Bonjer HJ, Deijen CL, Abis GA. et al. A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med 2015;373:1324–32.
    1. Fleshman J, Branda M, Sargent DJ. et al. Effect of laparoscopic-assisted resection vs open resection of stage II or III rectal cancer on pathologic outcomes: the ACOSOG Z6051 randomized clinical trial. JAMA 2015;314:1346–55.
    1. Stevenson ARL, Solomon MJ, Lumley JW. et al. Effect of laparoscopic assisted resection vs open resection on pathological outcomes in rectal cancer. The ALaCaRT randomized clinical trial. JAMA 2015;314:1356–63.
    1. Kamiński JP, Pai A, Ailabouni L. et al. Role of epidural and patient-controlled analgesia in site-specific laparoscopic colorectal surgery. JSLS 2014;18:Pii: e204.00207.
    1. Winslow ER, Fleshman JW, Birnbaum EH. et al. Wound complications of laparoscopic vs open colectomy. Surg Endosc 2002;16:1420–5.
    1. Wolthuis AM, de Buck van Overstraeten A, D'Hoore A.. Laparoscopic natural orifice specimen extraction-colectomy: a systematic review. World J Gastroenterol 2014;20:12981–92.
    1. Guan X, Wang GY, Zhou ZQ. et al. Retrospective study of 718 colorectal neoplasms treated by natural orifice specimen extraction surgery in 79 hospitals. Chin J Colorec Dis (Electronic Edition) 2017;6:469–77.
    1. Park JS, Choi GS, Kim HJ. et al. Natural orifice specimen extraction versus, conventional laparoscopically assisted right hemicolectomy. Br J Surg 2011;98:710–5.
    1. Costantino FA, Diana M, Wall J. et al. Prospective evaluation of peritoneal fluid contamination following transabdominal vs. transanal specimen extraction in laparoscopic left-sided colorectal resections. Surg Endosc 2012;26:1495–500.
    1. Karagul S, Kayaalp C, Sumer F. et al. Success rate of natural orifice specimen extraction after laparoscopic colorectal resections. Tech Coloproctol 2017;21:295–300.
    1. Senft JD, Warschkow R, Diener MK. et al. The transvaginal hybrid NOTES versus conventionally assisted laparoscopic sigmoid resection for diverticular disease (TRANSVERSAL) trial: study protocol for a randomized controlled trial. Trials 2014;15:454..
    1. Nau P, Ellison EC, Muscarella P. et al. A review of 130 humans enrolled in transgastric NOTES protocols at a single institution. Surg Endosc 2011;25:1004–11.
    1. Wang XS. Prospects and challenges of NOSES, NOTES, taTME. Chin J Gastrointest Surg 2018;21:16–21.
    1. China NOSES Alliance. Expert consensus of natural orifice specimen extraction surgery in colorectal neoplasm (2017 edition). Chin J Colorec Dis (Electronic Edition) 2017;6:266–72.
    1. Abu Gazala M, Wexner SD.. Re-appraisal and consideration of minimally invasive surgery in colorectal cancer. Gastroenterol Rep (Oxf) 2017;5:1–10.
    1. Wolthuis AM, Penninckx F, D’Hoore A.. Laparoscopic sigmoid resection with transrectal specimen extraction has a good short-term outcome. Surg Endosc 2011;25:2034–8.
    1. Yagci MA, Kayaalp C, Novruzov NH.. Intracorporeal mesenteric division of the colon can make the specimen more suitable for natural orifice extraction. J Laparoendosc Adv Surg Tech A 2014;24:484–6.
    1. Torres RA, Orban RD, Tocaimaza L. et al. Transvaginal specimen extraction after laparoscopic colectomy. World J Surg 2012;36:1699–702.
    1. Nishimura A, Kawahara M, Honda K. et al. Totally laparoscopic anterior resection with transvaginal assistance and transvaginal specimen extraction: a technique for natural orifice surgery combined with reduced-port surgery. Surg Endosc 2013;27:4734–40.
    1. Wang XS. Natural Orifice Specimen Extraction Surgery. Berlin: Springer, 2018.
    1. Izquierdo KM, Unal E, Marks JH.. Natural orifice specimen extraction in colorectal surgery: patient selection and perspectives. Clin Exp Gastroenterol 2018;11:265–79.
    1. Fu C, Han J.. Strategy and technique for simultaneous resection of rectal cancer and liver metastasis. Chin J Gastrointest Surg 2017;20:618–20.
    1. Kang J, Min BS, Hur H. et al. Transanal specimen extraction in robotic rectal cancer surgery. Br J Surg 2012;99:133–6.
    1. Feng X, Morandi A, Boehne M. et al. 3-Dimensional (3D) laparoscopy improves operating time in small spaces without impact on hemodynamics and psychomental stress parameters of the surgeon. Surg Endosc 2015;29:1231–9.
    1. Cai JC, Hong XY.. Laparoscopic-assisted natural orifice specimen extraction radical descending colectomy using a Cai tube. World J Surg 2016;40:2803–7.
    1. Leroy J, Costantino F, Cahill RA. et al. Laparoscopic resection with transanal specimen extraction for sigmoid diverticulitis. Br J Surg 2011;98:1327–34.
    1. Ngu J, Wong AS.. Transanal natural orifice specimen extraction in colorectal surgery: bacteriological and oncological concerns. ANZ J Surg 2016;86:299–302.
    1. Park JS, Kang H, Park SY. et al. Long-term outcomes after Natural Orifice Specimen Extraction versus conventional laparoscopy-assisted surgery for rectal cancer: a matched case-control study. Ann Surg Treat Res 2018;94:26–35.
    1. Sehgal R, Cahill RA.. Advanced laparoscopic surgery for colorectal disease: NOTES/NOSE or single port? Best Pract Res Clin Gastroenterol 2014;28:81–96.
    1. Franklin ME Jr, Liang S, Russek K.. Natural orifice specimen extraction in laparoscopic colorectal surgery: transanal and transvaginal approaches. Tech Coloproctol 2013;17(Suppl 1):S63–7.
    1. McKenzie S, Baek JH, Wakabayashi M. et al. Totally laparoscopic right colectomy with transvaginal specimen extraction: the authors' initial institutional experience. Surg Endosc 2010;24:2048–52.
    1. Wang XS. Current challenges and prospects of NOSES in China. Chin J Colorec Dis (Electronic Edition) 2018;7:2–7.
    1. Awad Z, Griffin R.. Laparoscopic right hemicolectomy: a comparison of natural orifice vs. transabdominal specimen extraction. Surg Endosc 2014;28:2871–6.
    1. Saurabh B, Chang SC, Ke TW. et al. Natural orifice specimen extraction with single stapling colorectal anastomosis for laparoscopic anterior resection: feasibility, outcomes, and technical considerations. Dis Colon Rectum 2017;60:43–50.
    1. Xingmao Z, Haitao Z, Jianwei L. et al. Totally laparoscopic resection with natural orifice specimen extraction (NOSE) has more advantages comparing with laparoscopic-assisted resection for selected patients with sigmoid colon or rectal cancer. Int J Colorectal Dis 2014;29:1119–24.
    1. Kim HJ, Choi GS, Park JS. et al. Transvaginal specimen extraction versus conventional minilaparotomy after laparoscopic anterior resection for colorectal cancer: mid-term results of a case-matched study. Surg Endosc 2014;28:2342–8.
    1. Wolthuis AM, Fieuws S, Van Den Bosch A. et al. Randomized clinical trial of laparoscopic colectomy with or without natural-orifice specimen extraction. Br J Surg 2015;102:630–7.
    1. Hisada M, Katsumata K, Ishizaki T. et al. Complete laparoscopic resection of the rectum using natural orifce specimen extraction. World J Gastroenterol 2014;20:16707–13.
    1. Wolthuis AM, Meuleman C, Tomassetti C. et al. How do patients score cosmesis after laparoscopic natural orifce specimen extraction colectomy? Colorectal Dis 2015;17:536–41.

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