Robotic transabdominal specimen extraction vs. transanal specimen extraction for sigmoid and upper rectal cancer: a comparative analysis of short-term outcomes

Background Robotic assistance now holds a well-established place in managing sigmoid colon and upper rectal cancer (SURC). Natural orifice specimen extraction surgery (NOSES) is a highly representative mini-invasive procedure of colorectal cancer (CRC) surgery. We retrospectively compared perioperative endpoints between robot-assisted NOSES-IV (transanal specimen extraction) and TASE (transabdominal specimen extraction) in patients managed for SURC. Methods For 254 patients managed with robot-assisted NOSES-IV or TASE at the First Affiliated Hospital of Jiangxi Medical College, Nanchang University, clinicopathological data were collected retrospectively over the period January 2019 to January 2026. Ninety-one patients received NOSES-IV and 163 received TASE. Following propensity score matching (PSM), 83 patients were yielded per group; and their short-term perioperative outcomes were evaluated. Results The initial pathological condition was not significantly different in the two groups. Compared with the TASE group, the NOSES-IV group had shorter digestive tract reconstruction time (P < 0.001) and less intraoperative blood loss (P = 0.022). Patients in the NOSES-IV group also ambulated (P = 0.029), passed flatus (P = 0.018), and resumed oral intake earlier (P = 0.038). On postoperative days 1, 3, and 5, their C-reactive protein levels were lower (P = 0.017); they also had fewer incision-related complications(P = 0.014), shorter postoperative hospital stays (P = 0.034), and lower VAS (visual analog scale) scores (P = 0.008). Conclusion Robotic NOSES-IV is a safe and viable surgical option for appropriately screened patients with SURC. It reduces incisional complications and postoperative pain and accelerates recovery.