Wenli Bm Ma

Natural orifice specimen extraction surgery (NOSES) has emerged as an advanced minimally invasive technique that eliminates abdominal wall incisions for specimen retrieval; nevertheless, comparative data on its efficacy relative to conventional minilaparotomy-assisted extraction in colorectal cancer (CRC) remain limited. This retrospective analysis was conducted on 126 patients who underwent laparoscopic CRC resection at our institution, allocated to either the NOSES group (transanal specimen extraction, n = 49) or the conventional group (minilaparotomy-assisted extraction, n = 77), comparing perioperative parameters, postoperative recovery indicators, complication rates, and pathological outcomes. The NOSES group demonstrated significantly shorter time to first flatus (2.3 ± 0.9 vs 2.9 ± 1.1 days, P = .002), time to first liquid diet (3.1 ± 1.0 vs 3.8 ± 1.3 days, P = .001), and postoperative hospital stay (8.4 ± 3.2 vs 10.1 ± 4.1 days, P = .014). Visual analog scale pain scores on postoperative day 1 were significantly lower in the NOSES group (3.2 ± 1.1 vs 4.5 ± 1.3, P < .001), with reduced additional analgesic requirements (22.4% vs 44.2%, P = .014). Overall complication rates were significantly lower in the NOSES group (12.2% vs 24.7%, P = .043), with wound infections occurring exclusively in the conventional group (0% vs 6.5%, P = .045). No significant differences were observed in operative time, estimated blood loss, anastomotic leakage, lymph node yield, or R0 resection rate (all P > .05). In conclusion, NOSES appears to be a safe and feasible alternative to conventional minilaparotomy-assisted specimen extraction in highly selected patients with CRC, offering advantages in postoperative pain control, gastrointestinal function recovery, and wound-related complication reduction without compromising oncological integrity.

Papillary thyroid carcinoma (PTC) and papillary thyroid microcarcinoma (PTMC) are generally characterized as less invasive forms of thyroid cancer with favorable prognosis. However, once lateral cervical lymph node metastasis takes place, the prognosis may be significantly impacted. The purpose of this study was to evaluate whether there is a difference in the pattern of lateral lymph node metastasis between PTC and PTMC. A retrospective analysis was performed for PTC and PTMC patients that underwent central area dissection and unilateral lateral neck lymph node dissection (II–V area) between January 2020 and December 2021. Compared with PTMC group, the PTC group exhibited higher incidence of capsule invasion, extrathyroid invasion and lymphatic vessel invasion. Both the number and rate of central lymph nodes metastasis were elevated in the PTC group. While the number of lateral cervical lymph node metastasis was higher, the metastasis rate did not demonstrate significant difference. No significant differences were identified in the lymph node metastasis patterns between the 2 groups. The determination of the extent of lateral neck lymph node dissection solely based on the tumor size may be unreliable, as PTC and PTMC showed no difference in the number and pattern of lateral neck metastasis. Additional clinical data are warranted to reinforce this conclusion. For patients categorized as unilateral, bilateral, or contralateral cervical lymph node metastasis (including level I, II, III, IV, or V) or retropharyngeal lymph node metastasis who require unilateral lateral neck dissection, the size of the primary tumor may not need to be a central consideration when assessing and deciding the extent of lateral neck dissection.