Evaluation of the efficacy of natural orifice specimen extraction surgery versus conventional laparoscopic surgery for colorectal cancers: A systematic review and meta-analysis.

Summary

Across 31 studies (n=4637), NOSES improved wound and pain outcomes, shortened hospital stay, accelerated GI recovery, and enhanced cosmetic results, with comparable oncologic margins, nodal harvest, and 5-year survival versus conventional laparoscopy. Operative time was modestly longer.

Key Findings

• NOSES reduced wound infection (OR 0.22) and incisional hernia (OR 0.24) relative to conventional laparoscopy.
• Improved patient-centered outcomes: less pain (WMD −1.43), shorter hospital stay (WMD −1.25 days), smaller incisions (WMD −4.94 cm), faster GI recovery.
• Oncologic equivalence: similar anastomotic leak, nodal harvest, margins, and 5-year DFS/OS; operative time increased by ~14 minutes.

Clinical Implications

For eligible CRC patients and experienced teams, NOSES may reduce wound complications, pain, and scarring while preserving oncologic outcomes; training and case selection remain critical given longer operative times.

Limitations

• Heterogeneity across studies and predominance of retrospective designs may introduce bias.
• Long-term quality-of-life and cost-effectiveness were not uniformly reported.

Future Directions

Prospective multicenter RCTs comparing NOSES vs. conventional laparoscopy with standardized cosmetic/QoL metrics and cost analyses; learning-curve and training studies.