Comparative Outcomes of Natural Orifice Specimen Extraction Surgery, Laparoscopic Surgery, and Open Surgery for...

Area of Science:

• Colorectal Surgery
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Limited comparative data exists for natural orifice specimen extraction surgery (NOSes) versus laparoscopic surgery (LS) and open surgery (OS) in rectal cancer.
• Evidence regarding functional and long-term oncological outcomes of NOSes is particularly scarce.

Purpose of the Study:

• To compare short-term recovery, functional outcomes at 6 months, and long-term survival.
• The study evaluated NOSes, LS, and OS for rectal cancer within a uniform treatment period.

Main Methods:

• Multicenter retrospective analysis of prospectively collected real-world data.
• Inverse probability of treatment weighting was used to balance baseline characteristics.
• Data from 3,385 rectal adenocarcinoma patients across four tertiary centers in China (2017-2019) were analyzed.

Main Results:

• NOSes demonstrated the quickest short-term recovery, with less gastrointestinal recovery time, lower pain, and fewer wound complications than LS and OS.
• Both NOSes and LS showed superior functional outcomes (lower LARS and IPSS scores) compared to OS, with no significant difference between the minimally invasive methods.
• Long-term oncological outcomes (5-year DFS and OS) were similar across all three surgical approaches.

Conclusions:

• NOSes provides a significant short-term recovery advantage over OS, and a more modest benefit over LS.
• Functional and long-term oncological results are comparable among NOSes, LS, and OS.
• NOSes is a safe and effective minimally invasive option for selected rectal cancer patients when adhering to standardized oncological principles.