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Session: ePoster: Colon and Colorectal Cancer 15 (Mon115)

EP765 - Anorectal function after transanal natural orifice specimen extraction (NOSE) surgery for colorectal cancer: A systematic review and meta-analysis

Monday, May 12, 2025
1:20 PM – 1:25 PM PT

    ePoster Presenter(s)

  • Megan Chua

    House Officer
    National University Singapore (NUS)
    Singapore, Singapore

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • Prasad Palanisamy, MBBS(Hons) MRCS MPH MMED(Surgery) (he/him/his)

    General Surgery Resident
    Singapore General Hospital
    Singapore, Singapore

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Senior Author(s)

  • IS

    Isaac Seow-En, MD

    Senior Consultant
    Singapore General Hospital
    Singapore, Singapore

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • AL

    Ashley Lee, n/a

    Medical Student
    National University of Singapore
    Singapore, Singapore

    Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.
Megan Chua: This individual has no financial relationships with ineligible companies.
Prasad Palanisamy, MBBS(Hons) MRCS MPH MMED(Surgery): This individual has no financial relationships with ineligible companies.
Isaac Seow-En, MD: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Natural orifice specimen extraction (NOSE) via the anus or vagina is an alternative to conventional transabdominal specimen extraction (TASE) following laparoscopic colorectal cancer surgery. While NOSE is associated with reduced abdominal wounds and quicker postoperative recovery, transanal NOSE involves retrieval of the oncological specimen via the anus, which can result in considerable iatrogenic trauma to the sphincter, particularly for larger specimens. We aimed to compare the postoperative anorectal function among patients who underwent NOSE versus TASE following minimally invasive surgery for colorectal cancer.

Methods/Interventions: A systematic review and meta-analysis was conducted by searching EMBASE and MEDLINE databases for comparative studies evaluating anorectal function in patients who underwent transanal NOSE following laparoscopic colorectal surgery. Studies published in English from inception through August 2024 were included. Primary outcome measure was functional outcome at postoperative 6 months. Newcastle-Ottawa Quality Assessment Scale was used to assess risk of bias.

Results/Outcomes: In total, seven studies with 1322 patients were eligible for inclusion in this meta-analysis. They were all retrospective cohort studies. Six studies reported function using the Wexner Incontinence score, four used the PFDI-20 score, one used William’s Standard Classification and one used Kirwan’s Grade. There were no statistically significant differences in the 6-month Wexner Incontinence scores or PFDI-20 scores between patients who underwent NOSE compared with TASE, with a mean difference of 0.17 [95% CI: -0.01, 0.35] (p=0.07) and -0.01 [95% CI: -0.22, 0.21] (p=0.95), respectively. NOSE was not associated with worse anorectal function in any individual study across the studied time periods. Consistent with established data, NOSE was associated with lesser pain, quicker recovery and a comparable safety profile compared to TASE.

Conclusion/Discussion: Transanal NOSE is associated with similar short and long term function compared to conventional abdominal extraction in minimally invasive colorectal cancer surgery.