ORIGINAL RESEARCH article
Front. Surg.
Sec. Colorectal and Proctological Surgery
Comparative Outcomes of Natural Orifice Specimen Extraction Surgery Versus Totally Laparoscopic Surgery for Right-Sided Colon Cancer: A Single-Centre Propensity Score-Matched Study
Provisionally accepted
Zheng Xu1Yueyang Zhang1Jian Ma1Changyuan Gao1Haipeng Chen1Jianwei Liang1Zhaoxu Zheng1Guan Xu1*
Haitao Zhou2*Xishan Wang1*- 1Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Center for National Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- 2Center for National Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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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.
Keywords: Colon Cancer, Long-term prognosis, Natural orifice specimen extraction surgery, Postoperative Complications, Right hemicolectomy
Received: 30 Sep 2025; Accepted: 20 Jan 2026.
Copyright: © 2026 Xu, Zhang, Ma, Gao, Chen, Liang, Zheng, Xu, Zhou and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Guan Xu
Haitao Zhou
Xishan Wang
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