Advancing mid‐rectal cancer surgery: Unveiling the potential of natural orifice specimen extraction surgery in comparison to conventional laparoscopic‐assisted resection

Abstract

Abstract Background Mid‐rectal cancer treatment traditionally involves conventional laparoscopic‐assisted resection (CLAR). This study aimed to assess the clinical and therapeutic advantages of Natural Orifice Specimen Extraction Surgery (NOSES) over CLAR. Aims To compare the clinical outcomes, intraoperative metrics, postoperative recovery, complications, and long‐term prognosis between NOSES and CLAR groups. Materials & Methods A total of 136 patients were analyzed, with 92 undergoing CLAR and 44 undergoing NOSES. Clinical outcomes were evaluated, and propensity score matching (PSM) was employed to control potential biases. Results The NOSES group exhibited significant improvements in postoperative recovery, including lower pain scores on days 1, 3, and 5 (p < .001), reduced need for additional analgesics (p = .02), shorter hospital stays (10.8 ± 2.3 vs. 14.2 ± 5.3 days; p < .001), and decreased intraoperative blood loss (48.1 ± 52.7 mL vs. 71.0 ± 55.0 mL; p = .03). Patients undergoing NOSES also reported enhanced satisfaction with postoperative abdominal appearance and better quality of life. Additionally, the NOSES approach resulted in fewer postoperative complications. Conclusion While long‐term outcomes (overall survival, disease‐free survival, and local recurrence rates) were comparable between the two methods, NOSES demonstrated superior postoperative outcomes compared to CLAR in mid‐rectal cancer treatment, while maintaining similar long‐term oncological safety. These findings suggest that NOSES could serve as an effective alternative to CLAR without compromising long‐term results.

Keywords

• conventional laparoscopic‐assisted resection
• long‐term outcomes
• mid‐rectal cancer
• natural orifice specimen extraction surgery
• postoperative recovery
• quality of life