Application of NOSES Combined with ERAS in the Treatment of Rectal Cancer

Abstract Background: In recent years, Natural Orifice Specimen Extraction Surgery (NOSES) has been developed rapidly, and the feasibility and advantages of Enhance Recovery after Surgery (ERAS) also have been recognized in colorectal cancer. How about combining NOSES with ERAS? In this article, we are trying to answer this question. Methods: The 120 cases of rectal cancer patients who met the inclusion criteria from January 2018 to December 2019 were divided into three groups using the random number table method: traditional care control group (laparoscopic assisted surgery + traditional care), ERAS control group (laparoscopic adjuvant surgery + ERAS) and experimental group (NOSE + ERAS), 40 cases in each group, randomized controlled study was performed. Results: There were no significant differences in surgical time, bleeding volume, number of detected lymph nodes, incidence of venous thrombosis in the lower extremities, anastomotic leakage, and abdominal infection among the three groups (P> 0.05). The total complication rate, incidence of incision-related complications, incidence of pulmonary and urinary tract infections, and postoperative pain NRS score in the NOSES+ERAS group cases were significantly lower than those in the other two control groups. Patients in the NOSES + ERAS group had higher satisfaction rates and shorter postoperative hospital stay than those in the other two control groups. The feeding time and exhaust time after surgery in NOSES+ERAS group and ERAS control group were earlier than those in traditional care control group. The above differences are statistically significant (P <0.05). Conclusion: The NOSES radical resection of rectal cancer under the guidance of ERAS achieved more minimally invasive cosmetic and functional, individualized treatment effect in laparoscopic surgery. There is a greater advantage that ERAS combined with the NOSES radical resection of rectal cancer which is worthy of popularization and with good application prospect.