title: Transanal natural orifice specimen extraction for laparoscopic anterior resection in rectal cancer.
abstract: OBJECTIVE
  To investigate whether transanal natural orifice specimen extraction (NOSE) is a better technique for rectal cancer resection.
  
  
  METHODS
  A prospectively designed database of a consecutive series of patients undergoing laparoscopic low anterior resection for rectal cancer with various tumor-node-metastasis classiﬁcations from March 2011 to February 2012 at the First Affiliated Hospital of Sun Yat-Sen University was analyzed. Patient selection for transanal specimen extraction and intracorporeal anastomosis was made on the basis of tumor size and distance of rectal lesions from the anal verge. Demographic data, operative parameters, and postoperative outcomes were assessed.
  
  
  RESULTS
  None of the patients was converted to laparotomy. Respectively, there were 16 cases in the low anastomosis and five in the ultralow anastomosis groups. Mean age of the patients was 45.4 years, and mean body mass index was 23.1 kg/m². Mean distance of the lower edge of the lesion from the anal verge was 8.3 cm. Mean operating time was 132 min, and mean intraoperative blood loss was 84 mL. According to the principle of rectal cancer surgery, we performed D2 lymph node dissection in 13 cases and D3 in eight. Mean lymph nodes harvest was 17.8, and the number of positive lymph nodes was 3.4. Median hospital stay was 6.7 d. No serious postoperative complication occurred except for one anastomotic leakage. All patients remained disease free. Mean Wexner score was 3.7 at 11 mo after the operation.
  
  
  CONCLUSIONS
  Transanal NOSE for total laparoscopic low/ultralow anterior resection is feasible, safe and oncologically sound. Further studies with long-term outcomes are needed to explore its potential advantages.
authors.affiliation: Fang-Hai Han, Li-Xin Hua, Zhi Zhao, Jian-Hai Wu, Wen-Hua Zhan, Department of Gastrointestinal Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, Guangdong Province, China.
authors.forename: Fang-Hai
authors.initials: FH
authors.lastname: Han
authors.forename: Li-Xin
authors.initials: LX
authors.lastname: Hua
authors.forename: Zhi
authors.initials: Z
authors.lastname: Zhao
authors.forename: Jian-Hai
authors.initials: JH
authors.lastname: Wu
authors.forename: Wen-Hua
authors.initials: WH
authors.lastname: Zhan
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary / Q000601:surgery*; D000328:Adult; D057868:Anastomotic Leak / Q000209:etiology; D003082:Colectomy / Q000009:adverse effects / Q000379:methods*; D003113:Colonoscopy; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden
keywords: Laparoscopic anterior resection; Low/ultra-low anastomosis; Natural orifice specimen extraction; Total mesorectal excision; Transanal specimen extraction