Systematic Review and Meta-Analysis of Short- and Long-Term Outcomes Following Natural Orifice Specimen Extraction...

Natural orifice specimen extraction (NOSE) in colon cancer surgery raises concerns about intra-abdominal infection, peritoneal seeding, and local recurrence due to possible tumor cell implantation. This systematic review and meta-analysis compares complete intracorporeal resection with NOSE versus conventional laparoscopic colon resection, focusing on short-term outcomes and long-term oncological safety.

A systematic literature search was conducted for English-language human studies published until April 2025. Meta-analyses were performed. They evaluated postoperative outcomes that included operative time, intraoperative blood loss, overall morbidity, severe morbidity, time to first flatus, and length of hospital stay. Oncological outcomes included local and overall recurrence rates.

A total of 15 studies met the inclusion criteria, comprising 3 randomized controlled trials and 12 retrospective studies, involving 1683 patients, 733 in the NOSE group and 950 in the conventional group. Pooled analyses demonstrated significantly reduced intraoperative blood loss, lower overall postoperative morbidity, and shorter time to first flatus and postoperative hospital stay in the NOSE group. However, operative time was significantly longer in the NOSE group. The average of median follow-up periods across studies was 38.9 months, and no significant differences were observed between the two groups in terms of oncological outcomes.

This study supports NOSE as a practical and effective surgical approach in selected patients with colon cancer. It offers significant benefits, including fewer postoperative complications and faster patient recovery, while maintaining oncological outcomes comparable to conventional techniques. NOSE should be considered in clinical practice, tailored to patient preferences and individual clinical factors.