Hidekazu Takahashi, MD, PhD1, Atsushi Hamabe, MD, PhD2, Tsuyoshi Hata, MD, PhD1, Yuji Nishizawa, MD, PhD3, Atsushi Nishimura4, Masaaki Itoh3, Ichiro Takemasa, MD, PhD2. 1Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, 3Department of Colorectal and Pelvic Surgery, National Cancer Center Hospital East, 4Department of Surgery, Institute of Gastroenterology, Nagaoka Chuo General Hospital
Background: For colorectal cancer treatment, conventional laparoscopic surgery combined with a transvaginal specimen extraction (TVSE) was less painful than laparoscopic surgery with a small laparotomy. However, the relevance of TVSE combined with reduced port surgery (RPS) remains unknown. This study investigated the feasibility of TVSE with RPS. We also evaluated the pain, aesthetic satisfaction, and quality of life of patients after TVSE with RPS.
Methods: This prospective multicenter study enrolled 10 patients with colorectal cancer that underwent RPS with TVSE at three institutions. This study is registered with UMIN-CTR, UMIN000016859. A pre-specified protocol specified the surgical approach, colorectal resection procedures, and the transvaginal approach. We administered questionnaires to assess pain (visual analogue scale [VAS]), subjective/objective wound healing aesthetics (photo series questionnaires [PSQ]), and quality of life (QOL).
Results: The median estimated blood loss was 32 ml (range <1 to 154 ml). Resected specimen findings indicated that oncological clearance was secured in all cases. No operative complications occurred, except one urinary tract infection, which was promptly cured with antibiotics. On day 0, pain was rated 2.3 ± 0.67 at rest and 4.9 ± 0.82 during sneezing; these ratings gradually declined over time. The QOL scores showed that, compared to before surgery, after surgery, patients reported significant deterioration of physical functioning (96.67±1.49 vs. 87.33±2.71), emotional functioning (93.33±2.72 vs. 86.67±2.22), fatigue (7.78±3.72 vs. 26.67±8.31), and pain (6.67±3.69 vs. 18.33±4.61). Nevertheless, no significant difference was observed on other scales. The PSQ showed that patient ratings of wound aesthetics after TVSE were not inferior to ratings from patients after conventional laparoscopy or single incision laparoscopic surgery, and they were significantly superior to patient ratings of wounds after laparotomy.
Conclusion: TVSE with RPS for colorectal cancer was feasible for the short-term surgical safety. Moreover, this approach might be less painful than other procedures for colorectal cancer.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 92440
Program Number: P350
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster