Modified natural orifice specimen extraction type IV surgery for rectosigmoid cancer: A retrospective clinical study

Abstract

BACKGROUND

The standard natural orifice specimen extraction surgery (NOSES) type IV procedure involves extensive manipulation of the lower gastrointestinal tract, which may result in prolonged operative time, increased consumption of surgical supplies, and delayed postoperative bowel function recovery. Therefore, we have developed a modified version of the NOSES procedure.

AIM

To retrospectively compare postoperative outcomes of standard NOSES and modified NOSES type IV technique for radical resection of rectosigmoid cancer.

METHODS

A retrospective analysis was performed on 40 patients who underwent NOSES type IV surgery for rectosigmoid cancer at Shenzhen People’s Hospital between July 2021 and October 2025. The patients were divided into two groups: 19 treated with the modified NOSES procedure (modified group) and 21 treated with the standard NOSES procedure (control group). The baseline characteristics, perioperative parameters, and postoperative recovery indicators were compared between the groups.

RESULTS

The modified group experienced less intraoperative blood loss, shorter operative time, and lower operative cost compared with the control group (all P < 0.05), and achieved earlier first defecation. One Grade B anastomotic leak occurred in the control group. Baseline characteristics, lymph node yield, postoperative pain, inflammatory markers, complication rates, and other recovery outcomes did not differ significantly between groups (all P > 0.05). In multivariable analysis, the modified procedure was independently associated with reduced operative cost (β = -1307, P < 0.001) and operative time (β = -49.9 minutes, P = 0.019). Larger tumor size and greater distance from the anus were associated with higher operative cost.

CONCLUSION

The modified NOSES technique may reduce operative trauma, shorten procedure time, lower perioperative resource use and accelerate postoperative recovery, with similar outcomes to the standard approach. These results require confirmation in larger, prospective multicenter studies.

Keywords: Natural orifice surgery; Rectosigmoid cancer; Laparoscopic surgery; Modified procedure; Postoperative complications

Core Tip: This study compared the conventional and modified natural orifice specimen extraction surgery (NOSES) type IV procedures for rectosigmoid cancer. Compared to the conventional technique, the modified technique had simplified operative steps and eliminated the need for a circular stapler, thereby reducing operative time, blood loss, and surgical costs without compromising oncological safety. Postoperative recovery, including bowel function and complication rates, was comparable between groups. These findings suggest that the modified NOSES IV approach is a safe, efficient, and cost-effective alternative for minimally invasive radical resection of rectosigmoid cancer.