Application of double purse-string anastomosis in optimizing laparoscopic NOSES surgery for rectal cancer under the payment system of DRGs

Natural transluminal specimen extraction surgery (NOSES) is used to treat rectal cancer (RC). However, under the payment system of diagnosis-related groups (DRGs), the application of double purse-string anastomosis (DPSA) in RC laparoscopic NOSES is unclear. This work compared the clinical efficacy and prognosis between DPSA and single purse-string anastomosis (SPSA) in RC laparoscopic NOSES. A retrospective analysis of 36 patients with RC laparoscopic radical resection at Zhejiang Jinhua Guangfu Tumor Hospital was conducted. Patients were clustered into the DPSA group (15 cases) and the SPSA group (21 cases) and were evaluated in terms of baseline characteristics, perioperative indicators, surgical complications, postoperative recovery, hospitalization costs, and prognosis. A significant difference was observed in gender between the two groups (P = 0.028). In terms of perioperative indicators, compared with the SPSA group, the anastomosis and reconstruction time in the DPSA group significantly increased (55.20 min vs. 39.52 min, P = 0.006), with a significant decrease in the intraoperative bleeding volume (30 mL vs. 100 mL, P = 0.006) and the lymph node harvest (13.14 vs. 18.57, P = 0.049). We detected no significant difference in surgical complications or postoperative recovery between the two groups (P > 0.05). Compared with the SPSA group, the total hospital days (18.40 days vs. 20.67 days) and hospitalization costs (CNY 43,127.26 vs. CNY 46,855.49) in the DPSA group dropped by 10.98% and 7.96%, respectively. The cost index of DRGs in the DPSA group was significantly lower than that in the SPSA group (88.20% vs. 95.82%). Follow-up results revealed no significant differences in the recurrence rates (6.7% vs. 0%) in both groups (P > 0.05). Under the payment system of DRGs, the DPSA method for laparoscopic NOSES for RC is safe and feasible, which can reduce patients’ financial burden, facilitate the redistribution of medical resources, and save national medical insurance funds.