eP188 - Outcomes and Efficacy of the NICE (Natural-Orifice-Intracorporeal-Endoscopic-Surgery) Procedures in Colorectal Cancer Patients from 2018 to 2021: A Retrospective Observation Study

Purpose/Background: The advent of Robotic Natural Orifice Intracorporeal Endoscopic Surgery (NICE) offers a novel minimally invasive surgical approach to reduce operative morbidity and improve postoperative outcomes. Utilizing natural orifices for specimen extraction and anastomosis formation could potentially reduce surgical trauma, reduce wound-related complications, and potentially expedite postoperative recovery. Moreover, NICE might contribute to lower opioid use and better cosmetic outcomes due to fewer abdominal incisions, which can be particularly beneficial in the patient-centered care paradigm. Concerns regarding adherence to oncologic principles have been raised, particularly in regard to the transrectal extraction of a malignant specimen and the risk of local recurrence and overall survival. Therefore, a detailed evaluation of NICE procedures in the context of colorectal cancer patients is important to understand its potential as a standard surgical intervention for colorectal cancer patients. The study's primary outcome was to evaluate oncologic outcomes, including recurrence and survival rates. The second objective included assessing the intraoperative and postoperative characteristics and outcomes for malignant left-sided disease.Methods/Interventions: A retrospective study was conducted on consecutive colorectal cancer patients who underwent NICE procedures from 2018 to 2021. Patients were included if they had undergone NICE procedure in stages 1,2, or 3 and were not a candidate for neoadjuvant treatment. Patients with locally advanced or metastatic disease were excluded. Data related to demographic characteristics, clinical outcomes, and oncologic endpoints were collected and analyzed.Results/Outcomes: A total of 65 patients with a median age of 61 years (IQR of 53 – 68) were included. The cohort predominantly comprised males (66.2%), with a median ASA grade of 3 (IQR of 2 – 3) and a median BMI of 27.1 (IQR of 25.1 – 30.4). Cancer was most prevalent in the rectal region (50.8%), followed by the sigmoid (41.5%) and rectosigmoid (7.7%) regions. Disease staging revealed 22 (33.8%) at stage I, 13 (20%) at stage II, and 30 (46.2%) at stage III. All procedures were performed robotically with no conversions to open surgery. The median operative time and estimated blood loss were 231 minutes (IQR 187 – 288) and 50 mL (IQR 25 – 55), respectively. The median hospital stay was 2 days (IQR of 2 to 3). Postoperative complications were observed in 6 (9.2%) patients, with one surgical site infection and no cases of anastomotic leak. Over a median follow-up of 41 months (IQR of 32.4 – 49.6), 12 patients experienced recurrence. Recurrence rates were higher in stage III (30%), followed by stage II (15%) and stage I (4.7%). Of the 12 cases of recurrent disease, 3 patients had local recurrence only, 3 had both local and distal disease recurrence, and 6 had distant recurrence only. All patients with local recurrence were among the cohort with stage III disease. Mortality was reported in four patients (6.2%).Conclusion/

Discussion: The study results demonstrate the potential efficacy and safety of NICE procedures in managing colorectal cancer. Low recurrence rates were observed among all cohorts in the subset of patients with stage I, II and III diseases. By obviating the need for an extraction incision and avoiding extra-corporal manipulation of the tissue, this approach may afford several patient benefits. The study advocates for further research with larger cohorts to determine broader applicability and benefits in colorectal cancer management.