title: Transvaginal specimen extraction versus conventional minilaparotomy after laparoscopic anterior resection for colorectal cancer: mid-term results of a case-matched study.
abstract: BACKGROUND
  Although the vagina is considered a viable route during laparoscopic surgery, a number of concerns have led to a need to demonstrate the safety of a transvaginal approach in colorectal surgery. However, the data for transvaginal access in left-sided colorectal cancer are extremely limited, and no study has compared the clinical outcomes with a conventional laparoscopic procedure.
  
  
  OBJECTIVE
  We compared the clinical outcomes of totally laparoscopic anterior resection with transvaginal specimen extraction (TVSE) with those of the conventional laparoscopic approach with minilaparotomy (LAP) for anastomosis construction and specimen retrieval in left-sided colorectal cancer.
  
  
  METHODS
  Fifty-eight patients underwent TVSE between October 2006 and July 2011 and were matched by age, surgery date, tumor location, and tumor stage with patients who underwent conventional LAP for left-sided colorectal cancer.
  
  
  RESULTS
  Operative time was significantly longer in the TVSE group (149.3 ± 39.8 vs. 131.9 ± 41.4 min; p = 0.023). Patients in the TVSE group experienced less pain (pain score 4.9 ± 1.6 vs. 5.8 ± 1.9; p = 0.008), shorter time to passage of flatus (2.2 ± 1.1 vs. 2.7 ± 1.2 days; p = 0.026), and higher satisfaction with the cosmetic results (cosmetic score 8.0 ± 1.4 vs. 6.3 ± 1.5; p = 0.001). More endolinear staplers for rectal transection were used in the LAP group (1.2 ± 0.5 vs. 1.1 ± 0.2; p = 0.021). Overall morbidities were similar in both groups; however, three wound infections only occurred in the LAP group. After a median follow-up of 34.4 (range 11-60) months, no transvaginal access-site recurrence occurred. The 3-year disease-free survival was similar between groups (91.5 vs. 90.8%; p = 0.746).
  
  
  CONCLUSIONS
  Transvaginal access after totally laparoscopic anterior resection is safe and feasible for left-sided colorectal cancer in selected patients with better short-term outcomes.
authors.affiliation: Colorectal Cancer Center, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, 807 Hogukno, Buk-gu, Daegu, 702-210, Korea.
authors.forename: Hye Jin
authors.initials: HJ
authors.lastname: Kim
authors.forename: Gyu-Seog
authors.initials: GS
authors.lastname: Choi
authors.forename: Jun Seok
authors.initials: JS
authors.lastname: Park
authors.forename: Soo Yeun
authors.initials: SY
authors.lastname: Park
authors.forename: Jong Pil
authors.initials: JP
authors.lastname: Ryuk
authors.forename: Sung Hwan
authors.initials: SH
authors.lastname: Yoon
mesh_terms: D016058:Analgesia, Patient-Controlled; D000714:Anastomosis, Surgical; D015179:Colorectal Neoplasms / Q000401:mortality / Q000601:surgery*; D018572:Disease-Free Survival; D004954:Esthetics; D005260:Female; D005414:Flatulence; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy / Q000379:methods; D016555:Matched-Pair Analysis; D008875:Middle Aged; D061646:Operative Time; D010147:Pain Measurement; D017060:Patient Satisfaction; D011183:Postoperative Complications; D013528:Surgical Staplers; D014621:Vagina / Q000601:surgery*