Natural Orifice Specimen Extraction Surgery for Colorectal Cancer (NOSE)
Colorectal Cancer
About this trial
This is an interventional treatment trial for Colorectal Cancer
Eligibility Criteria
Inclusion Criteria: Patient Enrollment Histological or cytological confirmation of colorectal adenocarcinoma. Inclusion criteria Age ≥ 18 Performance status of 0 - 2 on the ECOG (Eastern Cooperative Oncology Group) scale American Society of Anesthesiology (ASA) score is Ⅰ-Ⅲ Tumor location: CRC with the lower margin of the tumor greater than 10 cm from the anal verge Pre-operative T staging: T0-T4a at preoperative evaluation according to the American Joint Committee on Cancer (AJCC) Cancer Staging Manual 8th Edition Preoperative M staging: M0 according to AJCC 8th Tumor size: 4 cm or less Written informed consent for participation Exclusion Criteria: Not suitable for minimally invasive surgery Body mass index (BMI) >30 kg/m2 Malnutrition: albumin level less than 3.5 Previous pelvic surgery Emergency surgery
Sites / Locations
Arms of the Study
Arm 1
Arm 2
No Intervention
Experimental
Conventional laparoscopy group
NOSE group
The investigators can select either the intracorporeal or extracorporeal method to create bowel anastomoses. For the extracorporeal way, a mini-laparotomy wound is created and exteriorizes the bowel to do the anastomosis. The specimen is removed via the mini-laparotomy wound after the anastomosis is accomplished for the intracorporeal approach.
After bowel resection, all bowel anastomoses are created via side-to-side intracorporeal anastomosis, either isoperistaltic or antiperistaltic. The surgical steps of NOSE with the transrectal method are illustrated in Figure 1. First, the rectosigmoid colonic lumen is blocked with a bowel clamp. After rectal irrigation with povidone-iodine water, a transanal endoscopic microsurgery (TEM) scope or Alexis wound protector is inserted through the anus, reaching the upper rectum. Enterotomy is performed at the upper rectum, and a suction device is used to clean any fecal spillage. The TEM scope is pushed forward beyond the rectal opening, and the specimen is extracted with the TEM scope. The rectal opening is closed with a barbed suture, and an air leak test is performed to identify anastomotic leakage.