Comparative outcomes of natural orifice specimen extraction surgery versus conventional minilaparotomy-assisted specimen extraction in colorectal cancer

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.