Analysis of the clinical value of NOSES combined with ERAS in the treatment of rectal cancer

This study compares the clinical efficacy of natural orifice specimen extraction surgery (NOSES) combined with enhanced recovery after surgery (ERAS) to that of conventional laparoscopic surgery for treatment of rectal cancer.

This two-armed retrospective observational study without case-matched pairs included 100 patients with rectal cancer selected from the General Surgery Department of the Second Affiliated Hospital of Nanchang University from January 2019 to December 2021. The observation group comprised 49 patients treated with NOSES and ERAS, the control group 51 patients with laparoscopic surgery. Postoperative C‑reactive protein (CRP), procalcitonin (PCT), interleukin‑6 (IL-6), white blood cell count, percentage of neutrophils, K⁺ concentration, postoperative peristalsis recovery time, first time out-of-bed activity, first liquid feeding time, removal time of urinary and drainage tubes, hospital stay and intraoperative blood loss, number of lymph nodes detected, positive margin rate, incidence of complications, pain, and disease-free survival (DFS) were compared.

The observation group had lower postoperative CRP, PCT, and IL-6 levels than controls (P < 0.05), but there was no significant difference in K⁺ (P > 0.05). Times of intestinal peristalsis recovery, first out-of-bed activity, first liquid feeding, urinary and drainage tube removal, and hospitalization were shorter in the observation group (P < 0.05), but the duration of surgery was longer (P < 0.05). There were no significant differences in intraoperative bleeding, number of lymph nodes detected, rate of positive resection margins, or incidence of complications (P > 0.05). The observation group had lower pain scores on the first, second, and third day after surgery (P < 0.05). There was no significant difference in DFS between the groups (P > 0.05).

NOSES with ERAS for treatment of rectal cancer can reduce the surgical incision and alleviate the stress reaction and postoperative pain without increasing the recurrence rate. It is thus safe and feasible, improves therapeutic efficacy, reduces the complication rate, and is worthy of popularization and application.