Transvaginal specimen extraction in laparoscopic surgery for colorectal cancer: a systematic review and meta-analysis

BACKGROUND: Natural Orifice Specimen Extraction (NOSE) surgery uses the body's natural orifices as channels for removing surgical specimens. This approach obviates the requirement for an extra incision on the abdominal wall, which in turn further enhances the minimally invasive outcome of the surgical procedure. The vagina, which functions as a natural orifice, is widely used to extract specimens that have been surgically resected in the context of laparoscopic colorectal cancer surgery. This study aims to compare postoperative complications, oncological safety, pathological results, and short-term efficacy between transvaginal and transabdominal specimen extraction in laparoscopic colorectal cancer surgery. METHODS: This research adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Literature retrieval was conducted in the PubMed/MEDLINE, Web of Science, and EMBASE databases. Clinical data of postoperative complications, pathological results (proximal margin, distal margin, number of lymph nodes), oncological outcomes (DFS and OS), and short-term outcomes (hospital stay, pain score, additional analgesics, flatus time, time to first diet) were collected. Pooled estimates were derived using fixed- and random-effect models. RESULTS: Ultimately, 10 studies with a total of 823 patients were incorporated into the analysis. Compared with the LAP group, the TVSE group tended to have a lower incidence of postoperative complications (OR = 0.45, 95% CI:0.30 ~ 0.67). The pathological findings observed in the TVSE group appear comparable to those in the LAP group, with no apparent discrepancy in the number of retrieved lymph nodes (WMD = 0.54, 95% CI: -0.27 ~ 1.34). No obvious differences were found in disease-free survival (HR = 1.22, 95% CI: 0.72-2.08) and overall survival (HR = 0.76, 95% CI: 0.43-1.37). Compared with the LAP group, the TVSE group may show potential favourable trends in short-term outcomes. CONCLUSIONS: This meta-analysis suggests that the TVSE group may be associated with lower postoperative morbidity and more favorable recovery outcomes than the LAP group. No obvious unfavorable impact on oncological safety was seen in the TVSE group. Due to the observational design of the included studies, relevant conclusions remain inconclusive. More high-quality studies are required to validate these results.