Aim To evaluate the safety, feasibility, and long-term efficacy of natural orifice specimen extraction surgery (NOSES) compared with totally laparoscopic right hemicolectomy (TLRH) for right-sided colon cancer. Methods This single-center retrospective study included 349 patients who underwent laparoscopic curative resection for stage I-III right-sided colon cancer between January 2018 and January 2023. After 1:1 propensity score matching (PSM) for age, tumor size, BMI, neoadjuvant therapy, and T stage, 115 NOSES patients were compared with 115 TLRH patients. Outcomes included postoperative recovery, perioperative fatigue, complications, pelvic floor function, disease-free survival (DFS), and overall survival (OS). Results After PSM, baseline characteristics were balanced. Operative time and blood loss did not differ between groups. NOSES was associated with significantly less postoperative pain ( P 0.001) and lower analgesic use (25.2% vs. 47.0%, P 0.001). Learning curves indicated proficiency after 57 transvaginal and 32 transrectal procedures. Recovery indicators, including time to first flatus, defecation, and hospital stay, were comparable. Incision-related complications occurred more frequently in TLRH ( P = 0.024). NOSES patients reported lower fatigue levels on postoperative days 1 and 3 ( P 0.001), with fewer cases of postoperative fatigue syndrome. Pelvic floor and continence outcomes were similar. No local recurrences were observed, and DFS and OS did not differ significantly. Conclusions NOSES is a safe and effective alternative for selected patients with right-sided colon cancer. It reduces postoperative pain, fatigue, and incision-related complications without compromising oncological outcomes or pelvic floor function, and demonstrates a clear learning curve supporting its broader application.
Xu et al. (Wed,) studied this question.
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