Article Abstract

Hybrid natural orifice transluminal endoscopic surgery colectomy versus conventional laparoscopic colectomy for left-sided colonic tumors: intermediate follow up of a randomized trial

Authors: Karen Lok Man Tung, Michael Ka Wah Li


Background: In 2009, we have described a novel technique of laparoscopic colectomy without abdominal incision [hybrid natural orifice transluminal endoscopic surgery (NOTES) colectomy] where laparoscopic dissection and intra-corporeal anastomosis were performed as usual but the specimen was delivered through the anus with the use of transanal endoscopic operation (TEO) device set-up without mini-laparotomy. We have completed a randomized trial comparing this technique with conventional laparoscopic colectomy (CL) for left sided colonic tumors, and early short term results had showed that in selected group of patients, they can enjoy the full benefit of minimally invasive surgery with significant lesser wound pain as well as a lower wound infection rate. This study is a follow up of previous trial, and aims to report immediate outcome between the two groups.
Method: All 70 patients including 35 patients in the hybrid NOTES group and 35 patients in conventional colectomy group were continued to follow up in our outpatient clinic with regular surveillance. Patients were compared for clinicopathological variables, disease recurrence and survival rates.
Results: Clinicopathological details were comparable between the two groups. Within median follow up of 37–45 months in the two groups, no statistically significant difference was observed in disease recurrence rate (conventional: 8.57%; hybrid: 5.71%; P value: 0.22) and 3-year disease free survival rates (conventional: 42%; hybrid: 62%; P value: 0.144). While the overall 3-year survival rate is statistically shorter in the conventional group (conventional: 54%; hybrid: 71%; P value <0.05).
Conclusions: It is safe for us to offer hybrid colectomy for selected patients with left sided colonic cancer, without adversely affect their oncological outcome and survival, while at the same time, benefit of minimally invasive surgery can be fully expressed.