Pathology analysis of laparoscopic natural orifice specimen extraction surgery for rectal cancer based on propensity score matching
Objective To investigate and analyze the pathology of laparoscopic natural orifice specimen extraction surgery(NOSES)and assisted incision specimen removal for rectal cancer based on tendency score matching.Methods A total of 89 patients with rectal cancer who were admitted to our hos-pital from February 2017 to October 2019 were included in the study by propensity score matching method.According to the difference of operation methods,44 cases were fallen into study group and 45 cases into control group.The control group was treated with assisted incisions and the study group was treated with NOSES.The differences in perioperative indicators,postoperative complications,recurrence,distant me-tastasis,disease-free survival rate,and the expression levels of cyclooxygenase-2(COX-2),prostaglandin E2(PGE2),Beta-catenin(β-catenin),and microRNA(miR)-21,miR-196a,miR-23a before and after surgery were analyzed.The t-test was used for measurement data and x2 test for counting data.Results There was no significant difference between two groups in post-operative infection rate[2.27％(1/44)vs.4.44％(2/45)],the incidence of intestinal obstruction[2.27％(1/44)vs.0(0/45)],anastomotic fis-tula[2.27％(1/44)vs.4.44％(2/45)]and incisional hernia[0(0/44)vs.2.22％(1/45)],x2=0.322,1.034,0.322,0.989,P＞0.05.There was no significant difference between two groups in the recurrence rates[4.55％(2/44)vs.6.67％(3/45)],distant metastasis rate[4.55％(2/44)vs.2.22％(1/45)]and disease-free survival rate[93.18％(41/44)vs.88.89％(40/45)],x2=0.189,0.369,0.501,P＞0.05.After treatment,COX-2[(27.60±1.23)vs.(44.12±2.37)ng/ml,(28.11±1.34)vs.(44.20±2.51)ng/ml],PGE 2[(31.25±1.73)vs.(42.15±2.37)pg/ml,(31.36±1.80)vs.(42.35±2.40)pg/ml],and β-catenin[(41.56±2.73)vs.(61.78±3.81)ng/ml,(42.33±2.76)vs.(62.34±3.85)ng/ml]in both groups were lower than those before the same treatment(t=41.039,24.641,28.616,37.935,24.574,28.336,P＜0.05).After treat-ment,the expression of miR-21(1.03±0.18 vs.4.13±0.56 and 2.54±0.23 vs.4.09±0.42),miR-196a(1.02±0.25 vs.1.71±0.25,1.27±0.18 vs.1.69±0.31)and miR-23a(0.94±0.25 vs.2.54±0.46,1.21±0.17 vs.2.49±0.47)in both groups was lower than that before treatment,t=34.958,12.946,20.272,21.714,7.860,17.180,P＜0.05),and that in the study group was lower than in the control group(1.03±0.18 vs.2.54±0.23,1.02±0.25 vs.1.27±0.18,0.94±0.25 vs.1.21±0.17,t=34.439,5.423,5.970,P＜0.05).Conclusion The long-term curative effect of NOSES in the treatment of rectal cancer is comparable to that of traditional laparoscopic surgery,but the postoperative recovery of NOSES is faster and may have higher clinical application value.
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