Comparing quality of life and psychological status in patients with rectal cancer after natural orifice specimen extraction surgery (NOSES) versus conventional laparoscopic surgery
https://doi.org/10.17238/2072-3180-2025-2-97-107
Abstract
Introduction. To evaluate and compare the quality of life and psychological status of patients after laparoscopic surgery for rectal cancer with Natural Orifice Specimen Extraction Surgery (NOSES) and with the conventional laparoscopic.
Materials and methods of research. This prospective study included patients at Sechenov University and Harbin medical university. Patients were segregated into NOSES group and CL group based on case-match method. QoL was assessed using the short-form 36 health survey (SF-36), Beck anxiety inventory (BAI), and Spielberger state-trait anxiety inventory (STAI) pre-operation, pre-discharge, postoperative 3 months, and postoperative 6 months.
Treatment results. A total of 30 patients (15 in NOSES group and 15 in CL group) were included. At three months postoperatively, role function, physical pain, and emotional state were better in the NOSES group than in the CL group (all p<0.05). At six months postoperatively, NOSES group patients with better than CL group patients in role function, physical function, vitality, social function, emotional state, and mental health (p<0.05). As for postoperative depression, patients in the NOSES group were significantly better than patients in the CL group before discharge (p=0.037) and three months after surgery (p=0.003). In terms of anxiety, patients’ state anxiety in the NOSES group were lower than CL group before discharge (p=0.016), and trait anxiety were better than CL group (p=0.015).
Conclusion. This research provides compelling evidence that NOSES offers significant advantages in postoperative QoL, psychological well-being, with comparable surgical outcomes of the CL approach.
About the Authors
S. K. EfetovRussian Federation
Efetov Sergey Konstantinovich – MD, PhD, Associate Professor, Head of the Surgical Department № 2 of the University Clinical Hospital № 4
119048, 15 Dovatora str., bldg. 2, Moscow
Y. Cao
Russian Federation
Cao Yu – postgraduate student at the Department of Faculty Surgery № 2 Clinical Hospital № 4
119048, 15 Dovatora str., bldg. 1, Moscow,
D. I. Khlusov
Russian Federation
Khlusov Denis Igorevich – postgraduate student and assistant at the Department of Faculty Surgery № 2 Clinical Hospital № 4
119048, 15 Dovatora str., bldg. 2, Moscow
P. D. Panova
Russian Federation
Panova Polina Dmitrievna – resident at the Department of Faculty Surgery № 2 Clinical Hospital № 4
119048, 15 Dovatora str., bldg. 2, Moscow
G. Wang
China
Guiyu Wang – MD, PhD, Associate Professor of the Department of Colorectal Cancer Surgery, The Second Affiliated Hospital
Harbin 150086, China
T. V. Khorobrykh
Russian Federation
Khorobrykh Tatyana Vitalievna – MD, PhD, Head of the Department of Faculty Surgery № 2
119048, 15 Dovatora str., bldg. 2, Moscow
References
1. Tenesa A., Dunlop M.G. New insights into the aetiology of colorectal cancer from genome-wide association studies. Nature Reviews Genetics, 2009, № 10(6), pp. 353–358. https://doi.org/10.1038/nrg2574
2. Wang G., Fan D., Gu J., Ding K., Fang X., Shen L., Xu Z., Xu J., Cai J. Association CoCCSCA-C. CACA guidelines for holistic integrative management of rectal cancer. Holistic Integrative Oncology, 2023, № 2. https://doi.org/10.1007/s44178-023-00023-2
3. Zhang H., Hu H., Huang R., Guan Z., Zheng M., Xu C., Li Z., Wang Y., Zhang W., Yu L. et al. Natural orifice specimen extraction surgery versus conventional laparoscopic-assisted resection for colorectal cancer in elderly patients: a propensity-score matching study. Updates Surg, 2022, № 74(2), pp. 599–607. https://doi.org/10.1007/s13304-021-01143-y
4. Zhu Y., Xiong H., Chen Y., Liu Z., Jiang Z., Huang R., Gao F., Zhang Q., Wang M., Jin Y. Comparison of natural orifice specimen extraction surgery and conventional laparoscopic-assisted resection in the treatment effects of low rectal cancer. Scientific Reports, 2021, № 11(1), pp. 9338. https://doi.org/10.1038/s41598-021-88790-8
5. Efetov S.K., Cao Yu., Khlusov D.I., Zubayraeva A.A., Krasnov Ya.P. Short-term outcomes of colorectal cancer treatment after natural orifice specimen extraction surgery (NOSES) and with conventional laparoscopy. Moscow Surgical Journal, 2024, № 4, pp. 116–125. (In Russ.) https://doi.org/10.17238/2072-3180-2024-4-116-125
6. Tuomisto A.E., Mäkinen M.J., Väyrynen J.P. Systemic inflammation in colorectal cancer: underlying factors, effects, and prognostic significance. World J Gastroenterol, 2019, № 25(31), pp. 4383. https://doi.org/10.3748/wjg.v25.i31.4383
7. Efetov S.K., Tulina I.A., Kim V.D., Kitsenko Y., Picciariello A., Tsarkov P.V. Natural orifice specimen extraction (NOSE) surgery with rectal eversion and total extra-abdominal resection. Tech Coloproctol, 2019, № 23(9), pp. 899–902. https://doi.org/10.1007/s10151-019-02058-y
8. Ho M., Ho J.W.C., Fong D.Y.T., Lee C.F., Macfarlane D.J., Cerin E., Lee A.M., Leung S., Chan W.Y.Y., Leung I.P.F. et al. Effects of dietary and physical activity interventions on generic and cancer-specific health-related quality of life, anxiety, and depression in colorectal cancer survivors: a randomized controlled trial. J Cancer Surviv, 2020, № 14(4), pp. 424–433. https://doi.org/10.1007/s11764-020-00864-0
9. Tsarkov P., Liu Z., Zubayraeva A., Marchuk A., Korolev G., Liu E., Wang X., Efetov S. Natural orifice specimen extraction surgery (NOSES) for colon cancer treatment: a double-center case-matched study of surgical and short-term postoperative outcomes. Chin Med J (Engl), 2023, № 136(10), pp. 1234–1236. https://doi.org/10.1097/CM9.0000000000002663.
10. Guan X., Liu Z., Longo A., Cai J.C., Tzu-Liang Chen W., Chen L.C., Chun H.K., Manuel da Costa Pereira J., Efetov S., Escalante R., He Q.S., Hu J.H., Kayaalp C., Kim S.H., Khan J.S., Kuo L.J., Nishimura A., Nogueira F., Okuda J., Saklani A., Shafik A.A., Shen M.Y., Son J.T., Song J.M., Sun D.H., Uehara K., Wang G.Y., Wei Y., Xiong Z.G., Yao H.L., Yu G., Yu S.J., Zhou H.T., Lee S.H., Tsarkov P.V., Fu C.G., Wang X.S.; International Alliance of NOSES. International consensus on natural orifice specimen extraction surgery (NOSES) for colorectal cancer. Gastroenterol Rep (Oxf), 2019, № 7(1), pp. 24–31. PMID: 30792863; PMCID: PMC6375350. https://doi.org/10.12998/wjcc.v7.i24.4314
11. Renna M.E., Shrout M.R., Madison A.A., Alfano C.M., Povoski S.P., Lipari A.M., Carson W.E., 3rd, Malarkey W.B., Kiecolt-Glaser J.K. Depression and anxiety in colorectal cancer patients: Ties to pain, fatigue, and inflammation. Psychooncology, 2022, № 31(9), pp. 1536–1544. https://doi.org/10.1002/pon.5986
12. Zhu Z., Wang K.J., Orangio G.R. et al. Clinical efficacy and quality of life after transrectal natural orifice specimen extraction for the treatment of middle and upper rectal cancer. J Gastrointest Oncol, 2020, № 11(2), pp. 260–268. https://doi.org/10.21037/jgo.2020.03.05
13. Zhao S., Zhang L., Gao F. et al. Transanal Drainage Tube Use for Preventing. Anastomotic Leakage After Laparoscopic Low Anterior Resection in Patients with Rectal Cancer: A Randomized Clinical Trial. JAMA Surg., 2021, № 156(12), pp. 1151–1158. https://doi.org/10.1001/jamasurg.2021.4568
Review
For citations:
Efetov S.K., Cao Y., Khlusov D.I., Panova P.D., Wang G., Khorobrykh T.V. Comparing quality of life and psychological status in patients with rectal cancer after natural orifice specimen extraction surgery (NOSES) versus conventional laparoscopic surgery. Moscow Surgical Journal. 2025;(2):97-107. (In Russ.) https://doi.org/10.17238/2072-3180-2025-2-97-107