Total transvaginal natural orifice endoscopic surgery (v-NOTES) for colon cancer: A prospective cohort pilot study.

Abstract

e15617 Background: The abdominal incisions after laparoscopic colorectal cancer surgery remain to bother surgeons and patients due to cosmetic concerns, potential scarring and related complications. Total transvaginal natural orifice endoscopic surgery (total v-NOTES) has emerged as a totally scarless and promising alternative. This cohort pilot study endeavors to evaluate the safety, feasibility, and long-term survival outcomes of employing total v-NOTES in the management of colon cancer for female patients. Methods: This non-randomized prospective cohort pilot study involved seven female patients who underwent total v-NOTES from September 2020 to January 2021 for Stage II or III colon cancer in our hospital. Demographic information, perioperative outcomes and oncological outcomes were recorded. Subsequently, overall survival (OS) was defined as the time period from surgery until death or loss of follow-up, and disease-free survival (DFS) was defined as the period from surgery until signs or symptoms of cancer, or loss of follow-up. 3-year OS and DFS were obtained from all patients. Results: For perioperative outcomes, the surgeries were successfully executed for all 7 patients via the transvaginal route, with no conversions to regular laparoscopic surgery. The median operative time was 275 minutes and the median estimated blood loss was 100 ml. No grade III or above postoperative complications by Clavien-Dindo grading were reported, and there were no readmissions within the 30-day postoperative period. For oncological outcomes, all patients achieved R0 resections, with no positive distal margin or circumferential margin. At least 12 lymph nodes were retrieved from all cases with a median of 14 harvested lymph nodes. At the 3-year follow-up, survival was maintained in all patients, with no instance of recurrence or metastasis. Conclusions: Total v-NOTES is a feasible and safe approach for selected patients with colon cancer, offering satisfactory perioperative and long-term outcomes. While these results are encouraging, further large-scale studies are essential to confirm its potential as a viable alternative to traditional laparoscopic surgery. Clinical trial information: NCT04527861 .