Abstract
OBJECTIVE: This study aims to compare the clinical efficacy of natural orifice specimen extraction surgery (NOSES) and conventional laparoscopic surgery (CLS) in the treatment of rectal cancer, assessing the advantages and disadvantages of both surgical approaches. METHODS: A propensity score matching (PSM) method was used to analyze 221 patients with rectal cancer treated at Qilu Hospital of Shandong University Dezhou Hospital (Dezhou People's Hospital) from January 2022 to January 2025. The NOSES group included 24 cases, while the CLS group included 197 cases. After 1:1 matching, 46 cases (23 in each group) were included. This study compared surgical time, blood loss, white blood cell count, C-reactive protein (CRP), visual analog scale (VAS) scores, time to passage of flatus, postoperative hospital stay, hospitalization costs, complications, and additional analgesia requirements between the two groups. RESULTS: The NOSES group showed significant advantages in time to passage of flatus (1.78 ± 0.60 d versus 3.57 ± 1.08 d, P < 0.001), time to get out of bed (1.13 ± 0.34 d versus 1.70 ± 0.47 d, P < 0.001), and VAS scores on postoperative days 1 (1.70 ± 0.56 versus 3.30 ± 1.26, P < 0.001), 3 (1.48 ± 0.51 versus 2.91 ± 1.24, P < 0.001), and 7 (1.13 ± 0.55 versus 2.30 ± 1.36, P < 0.001) compared with the CLS group. The NOSES group also required no additional analgesia (χ(2) = 9.684, P = 0.002). No significant differences were observed in surgical time, blood loss, or complication rates (P > 0.05). CONCLUSIONS: NOSES effectively alleviates postoperative pain, demonstrates significant minimally invasive advantages, and facilitates short-term patient recovery, highlighting its clinical value.