|Table of Contents|

Efficacy of NOSES surgery in the treatment of rectal cancer and establishment and validation of postoperative prognostic scoring system

Journal Of Modern Oncology[ISSN:1672-4992/CN:61-1415/R]

Issue:
2024 22
Page:
4317-4322
Research Field:
Publishing date:

Info

Title:
Efficacy of NOSES surgery in the treatment of rectal cancer and establishment and validation of postoperative prognostic scoring system
Author(s):
LI Changrui1; FAN Ling1; CHEN Junming1; CUI Shijian1; SHANG Xiuxin2
1.Department of Gastroenterology and Abdominal Hernia;2.Department of Computer Information,Guangyuan Central Hospital,Sichuan Guangyuan 628000,China.
Keywords:
natural orifice specimen extraction surgery; rectal cancer; efficacy; prognosis; laparoscopy; scoring system
PACS:
R735.3+7
DOI:
10.3969/j.issn.1672-4992.2024.22.016
Abstract:
Objective:To explore the efficacy of natural orifice specimen extraction surgery (NOSES) in the treatment of rectal cancer,analyze the independent risk factors for prognosis and death in rectal cancer patients,and construct a death risk scoring system.Methods:A total of 189 patients with rectal cancer treated in our hospital from February 2013 to March 2018 were selected as the study subjects,with 102 undergoing NOSES treatment and 87 undergoing traditional laparoscopic surgery.Based on the prognosis,the patients undergoing NOSES were divided into survival and death groups,and multi-factor analyses were used to identify independent risk factors for prognosis and death.A death risk prediction model and prognosis scoring system were constructed and validated.Results:Compared with traditional laparoscopic surgery,patients undergoing NOSES had earlier first flatus time,shorter postoperative hospital stay,and earlier initiation of liquid diet (P＜0.05).The 24-hour visual analog scale (VAS) score was lower in the NOSES group (P＜0.05).The incidence of postoperative complications was lower (P＜0.05),and the 5-year disease-free survival rate was higher (P=0.007).Multivariable Cox regression analysis showed that carcinoembryonic antigen (CEA) positive,carbohydrate antigen 19-9 (CA19-9) positive,vascular invasion (LVI) positive,perineural invasion (PNI) positive,and high tumor stroma ratio (TSR) were independent risk factors for prognosis and death in rectal cancer patients after NOSES surgery (P＜0.05).The receiver operating characteristic (ROC) curve and calibration curve demonstrated good accuracy and discrimination of the prediction model.Risk scores were assigned to each influencing factor,the results showed that as the score increased,the risk of prognosis and death in rectal cancer patients increased.The ROC evaluation result showed an area under the ROC curve of 0.842 (95%CI:0.813~0.879),indicating good discriminative ability of the model.Conclusion:NOSES surgery has better efficacy than traditional laparoscopic surgery in the treatment of rectal cancer.CEA positive,CA19-9 positive,LVI positive,PNI positive,and high TSR are independent risk factors affecting prognosis and death in patients undergoing NOSES surgery.The death risk scoring system constructed based on the death risk prediction model has good predictive ability for prognosis and death in rectal cancer patients.

References:

［1］CAO W,CHEN HD,YU YW,et al.Changing profiles of cancer burden worldwide and in China:a secondary analysis of the global cancer statistics 2020［J］.Chin Med J (Engl),2021,134(7):783-791.
［2］GEHRMAN J,ANGENETE E,BJORHOLT I,et al.Cost-effectiveness analysis of laparoscopic and open surgery in routine Swedish care for colorectal cancer［J］.Surg Endosc,2020,34(10):4403-4412.
［3］杨飖,傅传刚.NOSES在结肠直肠癌手术中的应用现状与展望［J］.外科理论与实践,2021,26(4):305-311. YANG Y,FU CG.The current status and prospects of NOSES in the surgery of colon and rectal cancer［J］.Journal of Surgical Concepts & Practice,2021,26(4):305-311.
［4］OUYANG Q,PENG J,XU S,et al.Comparison of NOSES and conventional laparoscopic surgery in colorectal cancer:bacteriological and oncological concerns［J］.Front Oncol,2020,10:946.
［5］中华人民共和国国家卫生健康委员会医政医管局,中华医学会肿瘤学分会.中国结直肠癌诊疗规范(2020年版)［J］.中国实用外科杂志,2020,40(6):601-625. Hosptial Authority of National Health Commission of The People's Republic of China,Chinese Society of Oncology,Chinese Medical Association.Chinese protocol of diagnosis and treatment of colorectal cancer(2020 edition)［J］.Chinese Journal of Practical Surgery,2020,40(6):601-625.
［6］YOU YN,HARDIMAN KM,BAFFORDTHE A,et al.American society of colon and rectal surgeons clinical practice guidelines for the management of rectal cancer［J］.Diseases of the Colon & Rectum,2020,63(9):1191-1222.
［7］KELLER DS,BERHO M,PEREZ RO,et al.The multidisciplinary management of rectal cancer［J］.Nat Rev Gastroenterol Hepatol,2020,17(7):414-429.
［8］WANI RA,JEHANGIR M,SHIEKH IA,et al.Efficacy of surgery for rectal cancer under regional anaesthesia during covid times［J］.Int J Acad Med Pharm,2023,5(3):1603-1606.
［9］GAO G,CHEN L,LUO R,et al.Short- and long-term outcomes for transvaginal specimen extraction versus minilaparotomy after robotic anterior resection for colorectal cancer:a mono-institution retrospective study［J］.World J Surg Oncol，2020,18(1):190.
［10］WANG S,TANG J,SUN W,et al.The natural orifice specimen extraction surgery compared with conventional laparoscopy for colorectal cancer:A meta-analysis of efficacy and long-term oncological outcomes［J］.Int J Surg,2022,97:106196.
［11］LIN J,LIN S,CHEN Z,et al.Meta-analysis of natural orifice specimen extraction versus conventional laparoscopy for colorectal cancer［J］.Langenbecks Arch Surg,2021,406(2):283-299.
［12］TANG Q,ZHU Y,XIONG H,et al.Natural orifice specimen extraction surgery versus conventional laparoscopic-assisted resection in the treatment of colorectal cancer:A propensity-score matching study［J］.Cancer Manag Res,2021,13:2247-2257.
［13］丁春明,郭玮,毛瑞芳,等.肿瘤DNA甲基化标志物检测及临床应用专家共识（2024版）［J/OL］.中国癌症防治杂志［2024-04-23］.http://kns.cnki.net/kcms/detail/45.1366.R.20240419.0914.002. DING CM,GUO W,MAO RF,et al.Expert consensus on detection and clinical application of tumor DNA methylation markers (2024 edition)［J/OL］.Chin J Oncol Prev Treat［2024-04-23］.http://kns.cnki.net/kcms/detail/45.1366.R.20240419.0914.002.
［14］白小慧,魏英,李王斌,等.SOX化疗方案配合华蟾素片治疗晚期胃癌患者的效果及对免疫、炎症指标和肿瘤标志物水平的影响［J］.临床医学研究与实践,2024,9(11):49-53. BAI XH,WEI Y,LI WB,et al.Effect of SOX chemotherapy regimen combined with cinobufotalin tablets in the treatment of patients with advanced gastric cancer and its influences on immune,inflammatory indexes and tumor markers levels［J］.Clinical Research and Practice,2024,9(11):49-53.
［15］LAKEMEYER L,SANDER S,WITTAU M,et al.Diagnostic and prognostic value of CEA and CA19-9 in colorectal cancer［J］.Diseases,2021,9(1):21.
［16］LUO H,SHEN K,LI B,et al.Clinical significance and diagnostic value of serum NSE,CEA,CA19-9,CA125 and CA242 levels in colorectal cancer［J］.Oncol Lett,2020,20(1):742-750.
［17］邱佳辉,蔡谦谦,杨彦,等.神经脉管浸润联合肿瘤间质比对结直肠癌预后的预测价值［J］.上海交通大学学报(医学版),2022,42(8):1070-1080. QIU JH,CAI QQ,YANG Y,et al.The predictive value of neurovascular invasion combined with tumor stromal ratio for the prognosis of colorectal cancer［J］.Journal of Shanghai Jiaotong University(Medical Science),2022,42(8):1070-1080.
［18］TING KC,LEE TL,LI WY,et al.Perineural invasion/lymphovascular invasion double positive predicts distant metastasis and poor survival in T3-4 oral squamous cell carcinoma［J］.Sci Rep,2021,11(1):19770.
［19］SULLIVAN L,PACHECO RR,KMEID M,et al.Tumor stroma ratio and its significance in locally advanced colorectal cancer［J］.Curr Oncol,2022,29(5):3232-3241.
［20］KANG G,PYO JS,KIM NY,et al.Clinicopathological significances of tumor-stroma ratio (TSR) in colorectal cancers:Prognostic implication of TSR compared to hypoxia-inducible factor-1α expression and microvessel density［J］.Curr Oncol,2021,28(2):1314-1324.

Memo

Memo:
-
Last Update: 1900-01-01