title: Laparoscopic resection with natural orifice specimen extraction versus conventional laparoscopy for colorectal disease: a meta-analysis.
abstract: OBJECTIVE
  We wished to determine the effects of laparoscopic resection using natural orifice specimen extraction (NOSE) for patients with colorectal disease through a meta-analysis.
  
  
  METHODS
  A study search was undertaken in PubMed, EMBASE, and Cochrane databases for eligible studies until December 2014. Duration of hospital stay, operation time, time to first flatus, pain score, cosmetic result, postoperative complications, and disease-free survival (DFS) were the main endpoints. The results were analyzed using RevMan v5.3.
  
  
  RESULTS
  Nine clinical studies involving 837 patients were included for final analyses. Laparoscopic resection with NOSE had a shorter duration of hospital stay (weighted mean difference (WMD) = -0.62 days, 95 % confidence interval (CI) [-0.95, -0.28], p < 0.01) and time to first flatus (WMD = -0.59 days, 95 % CI [-0.78, -0.41], p < 0.01), less postoperative pain (WMD = -1.43, 95 % CI [-1.95, -0.90], p < 0.01), and postoperative complications (odds ratio (OR) = 0.51, 95 % CI [0.36, 0.74], p < 0.01) with better cosmetic result (WMD = 1.37, 95 % CI [0.59, 2.14], p < 0.01). However, the operation time was significantly longer in the NOSE group (WMD = 20.97 min, 95 % CI [4.33, 37.62], p = 0.01). No significant difference was observed in DFS (hazard ratio (HR) = 0.88, 95 % CI [0.49, 1.57], p = 0.67).
  
  
  CONCLUSIONS
  Our meta-analysis supported the notion that laparoscopic resection with NOSE for colorectal disease can significantly reduce the duration of hospital stay, accelerate postoperative recovery with better cosmetic results, and in particular, result in less postoperative pain and fewer complications.
authors.affiliation: Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University, Shenyang, 110001, People's Republic of China. mabin0326cmu@163.com.
authors.forename: Bin
authors.initials: B
authors.lastname: Ma
authors.affiliation: Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University, Shenyang, 110001, People's Republic of China. qq_347310502@126.com.
authors.forename: Xuan-Zhang
authors.initials: XZ
authors.lastname: Huang
authors.affiliation: Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University, Shenyang, 110001, People's Republic of China. gaokaji16@163.com.
authors.forename: Peng
authors.initials: P
authors.lastname: Gao
authors.affiliation: Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University, Shenyang, 110001, People's Republic of China. zjh900521@163.com.
authors.forename: Jun-Hua
authors.initials: JH
authors.lastname: Zhao
authors.affiliation: Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University, Shenyang, 110001, People's Republic of China. songyongxi840309@126.com.
authors.forename: Yong-Xi
authors.initials: YX
authors.lastname: Song
authors.affiliation: Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University, Shenyang, 110001, People's Republic of China. sun2003999@163.com.
authors.forename: Jing-Xu
authors.initials: JX
authors.lastname: Sun
authors.affiliation: Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University, Shenyang, 110001, People's Republic of China. chenxiaowan1826@163.com.
authors.forename: Xiao-Wan
authors.initials: XW
authors.lastname: Chen
authors.affiliation: Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University, Shenyang, 110001, People's Republic of China. josieon826@sina.cn.
authors.forename: Zhen-Ning
authors.initials: ZN
authors.lastname: Wang
mesh_terms: D003108:Colonic Diseases / Q000601:surgery; D018572:Disease-Free Survival; D004954:Esthetics; D005414:Flatulence; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods*; D007902:Length of Stay; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects* / Q000379:methods*; D061646:Operative Time; D010149:Postoperative Pain / Q000209:etiology; D012002:Rectal Diseases / Q000601:surgery
keywords: Colorectal disease; Laparoscopic surgery; Meta-analysis; Natural orifice specimen extraction