{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T08:00:53Z","timestamp":1772006453233,"version":"3.50.1"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T00:00:00Z","timestamp":1771977600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      After PSM, baseline characteristics were balanced. Operative time and blood loss did not differ between groups. NOSES was associated with significantly less postoperative pain (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001) and lower analgesic use (25.2% vs. 47.0%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). 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 (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.024). NOSES patients reported lower fatigue levels on postoperative days 1 and 3 (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001), 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1716425","type":"journal-article","created":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T07:04:42Z","timestamp":1772003082000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative outcomes of natural orifice specimen extraction surgery versus totally laparoscopic surgery for right-sided colon cancer: a single-centre propensity score-matched study"],"prefix":"10.3389","volume":"13","author":[{"given":"Zheng","family":"Xu","sequence":"first","affiliation":[{"name":"Department of Colorectal Surgery, National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yueyang","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jian","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Changyuan","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haipeng","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianwei","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhaoxu","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xu","family":"Guan","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haitao","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xishan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,25]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"229","DOI":"10.3322\/caac.21834","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J Clin"},{"key":"B2","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1016\/S1470-2045(08)70310-3","article-title":"Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial","volume":"10","author":"Buunen","year":"2009","journal-title":"Lancet Oncol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"S35","DOI":"10.1007\/s10151-012-0937-z","article-title":"Extracorporeal versus intracorporeal ileocolic anastomosis","volume":"17","author":"Stein","year":"2013","journal-title":"Tech Coloproctol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"500","DOI":"10.21037\/jgo.2019.12.02","article-title":"Intracorporeal anastomosis versus extracorporeal anastomosis for minimally invasive colectomy","volume":"11","author":"Brown","year":"2020","journal-title":"J Gastrointest Oncol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"3933","DOI":"10.1007\/s00464-015-4704-x","article-title":"Laparoscopic right hemicolectomy: short- and long-term outcomes of intracorporeal versus extracorporeal anastomosis","volume":"30","author":"Hanna","year":"2016","journal-title":"Surg Endosc"},{"key":"B6","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1111\/ases.12070","article-title":"Advances in laparoscopic colorectal surgery: a review on NOTES and transanal extraction of specimen","volume":"7","author":"Leung","year":"2014","journal-title":"Asian J Endosc Surg"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1331","DOI":"10.1016\/j.scib.2022.05.014","article-title":"Short-term and oncological outcomes of natural orifice specimen extraction surgery (NOSES) for colorectal cancer in China: a national database study of 5055 patients","volume":"67","author":"Guan","year":"2022","journal-title":"Sci Bull (Beijing)"},{"key":"B8","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1016\/j.sopen.2022.08.001","article-title":"Is natural orifice specimen extraction surgery the future direction of minimally invasive colorectal surgery?","volume":"10","author":"Zhang","year":"2022","journal-title":"Surg Open Sci"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1198","DOI":"10.4240\/wjgs.v14.i11.1198","article-title":"Development and future perspectives of natural orifice specimen extraction surgery for gastric cancer","volume":"14","author":"Zhang","year":"2022","journal-title":"World J Gastrointest Surg"},{"key":"B10","doi-asserted-by":"publisher","first-page":"899","DOI":"10.1007\/s10151-019-02058-y","article-title":"Natural orifice specimen extraction (NOSE) surgery with rectal eversion and total extra-abdominal resection","volume":"23","author":"Efetov","year":"2019","journal-title":"Tech Coloproctol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"6661651","DOI":"10.1155\/2022\/6661651","article-title":"Laparoscopic natural orifice specimen extraction surgery versus conventional surgery in colorectal cancer: a meta-analysis of randomized controlled trials","volume":"2022","author":"Zhou","year":"2022","journal-title":"Gastroenterol Res Pract"},{"key":"B12","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1007\/s10151-024-03055-6","article-title":"Reduced-port laparoscopic right colonic resection with D3 lymph node dissection and transvaginal specimen extraction (NOSES VIIIa) for right colon cancer: clinical features","volume":"29","author":"Efetov","year":"2024","journal-title":"Tech Coloproctol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"2973","DOI":"10.1097\/JS9.0000000000002285","article-title":"Development and prospects of natural orifice specimen extraction surgery for colorectal cancer: a review article","volume":"111","author":"Huang","year":"2025","journal-title":"Int J Surg"},{"key":"B14","doi-asserted-by":"publisher","first-page":"e84191","DOI":"10.7759\/cureus.84191","article-title":"Natural orifice specimen extraction for right-sided colon cancer: a systematic review and meta-analysis of propensity score-matched studies","volume":"17","author":"Pompeu","year":"2025","journal-title":"Cureus"},{"key":"B15","doi-asserted-by":"publisher","first-page":"goad036","DOI":"10.1093\/gastro\/goad036","article-title":"Preliminary surgical outcomes of laparoscopic right hemicolectomy with transrectal specimen extraction: a propensity score matching study of 120 cases (with video)","volume":"11","author":"Zhang","year":"2023","journal-title":"Gastroenterol Rep (Oxf)"},{"key":"B16","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1093\/gastro\/goy055","article-title":"International consensus on natural orifice specimen extraction surgery (NOSES) for colorectal cancer","volume":"7","author":"Guan","year":"2019","journal-title":"Gastroenterol Rep (Oxf)"},{"key":"B17","doi-asserted-by":"publisher","first-page":"106787","DOI":"10.1016\/j.ijsu.2022.106787","article-title":"Surgical outcomes and sexual function after laparoscopic colon cancer surgery with transvaginal versus conventional specimen extraction: a retrospective propensity score matched cohort study","volume":"104","author":"Zhang","year":"2022","journal-title":"Int J Surg"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1541","DOI":"10.1200\/JCO.22.00046","article-title":"Preoperative chemotherapy for operable colon cancer: mature results of an international randomized controlled trial","volume":"41","author":"Morton","year":"2023","journal-title":"J Clin Oncol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"2063","DOI":"10.1007\/s00384-021-03945-3","article-title":"Neoadjuvant chemotherapy in locally advanced colon cancer: a systematic review and meta-analysis","volume":"36","author":"Gosavi","year":"2021","journal-title":"Int J Colorectal Dis"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1151","DOI":"10.1002\/1097-0142(19870901)60:5%3C1151::AID-CNCR2820600538%3E3.0.CO;2-G","article-title":"The memorial pain assessment card. A valid instrument for the evaluation of cancer pain","volume":"60","author":"Fishman","year":"1987","journal-title":"Cancer"},{"key":"B21","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1002\/bjs.1800690721","article-title":"Fatigue and cardiorespiratory function following abdominal surgery","volume":"69","author":"Christensen","year":"1982","journal-title":"Br J Surg"},{"key":"B22","doi-asserted-by":"publisher","first-page":"991","DOI":"10.1007\/s11136-018-2068-0","article-title":"Defining the cut-off point of clinically significant postoperative fatigue in three common fatigue scales","volume":"28","author":"N\u00f8stdahl","year":"2019","journal-title":"Qual Life Res"},{"key":"B23","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1016\/j.ijsu.2019.08.008","article-title":"Short-term efficacy of transvaginal specimen extraction for right colon cancer based on propensity score matching: a retrospective cohort study","volume":"70","author":"Asti","year":"2019","journal-title":"Int J Surg"},{"key":"B24","doi-asserted-by":"publisher","first-page":"763","DOI":"10.1007\/s00595-023-02789-4","article-title":"Incidence and risk factors of bowel dysfunction after minimally invasive rectal cancer surgery and discrepancies between the wexner score and the low anterior resection syndrome (LARS) score","volume":"54","author":"Ota","year":"2024","journal-title":"Surg Today"},{"key":"B25","doi-asserted-by":"publisher","first-page":"3442","DOI":"10.1007\/s00464-021-08665-x","article-title":"Cumulative summation analysis of learning curve for robotic-assisted hiatal hernia repairs","volume":"36","author":"Lin","year":"2022","journal-title":"Surg Endosc"},{"key":"B26","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1016\/j.ijsu.2019.07.025","article-title":"Short-term efficacy of transvaginal specimen extraction for right colon cancer based on propensity score matching: a retrospective cohort study","volume":"72","author":"Li","year":"2019","journal-title":"Int J Surg"},{"key":"B27","doi-asserted-by":"publisher","first-page":"260","DOI":"10.21037\/jgo.2020.03.05","article-title":"Clinical efficacy and quality of life after transrectal natural orifice specimen extraction for the treatment of middle and upper rectal cancer","volume":"11","author":"Zhu","year":"2020","journal-title":"J Gastrointest Oncol"},{"key":"B28","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1016\/j.jss.2020.03.064","article-title":"Transrectal natural orifice specimen extraction (NOSE) with oncological safety: a prospective and randomized trial","volume":"254","author":"Zhou","year":"2020","journal-title":"J Surg Res"},{"key":"B29","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1097\/01.sla.0000245495.79781.65","article-title":"Somatic and psychologic predictors of long-term unfavorable outcome after surgical intervention","volume":"245","author":"Peters","year":"2007","journal-title":"Ann Surg"},{"key":"B30","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1186\/s12871-024-02513-w","article-title":"Effects of esketamine on postoperative fatigue syndrome in patients after laparoscopic resection of gastric carcinoma: a randomized controlled trial","volume":"24","author":"Lin","year":"2024","journal-title":"BMC Anesthesiol"},{"key":"B31","doi-asserted-by":"publisher","first-page":"1131","DOI":"10.1007\/s004649900799","article-title":"Postoperative pain and fatigue after laparoscopic or conventional colorectal resections. A prospective randomized trial","volume":"12","author":"Schwenk","year":"1998","journal-title":"Surg Endosc"},{"key":"B32","doi-asserted-by":"publisher","first-page":"446","DOI":"10.1016\/j.psyneuen.2007.12.011","article-title":"Peritoneal inflammation and fatigue experiences following colorectal surgery: a pilot study","volume":"33","author":"Paddison","year":"2008","journal-title":"Psychoneuroendocrinology"},{"key":"B33","doi-asserted-by":"publisher","first-page":"1624","DOI":"10.1007\/s00464-008-9992-y","article-title":"Laparoscopic intracorporal colorectal sutured anastomosis using the radius surgical system in a phantom model","volume":"23","author":"Torres Bermudez","year":"2009","journal-title":"Surg Endosc"},{"key":"B34","doi-asserted-by":"publisher","first-page":"616","DOI":"10.1007\/s00595-021-02375-6","article-title":"Short-term outcomes of intracorporeal versus extracorporeal anastomosis after laparoscopic colectomy: a propensity score-matched cohort study from a single institution","volume":"52","author":"Ozawa","year":"2022","journal-title":"Surg Today"},{"key":"B35","doi-asserted-by":"publisher","first-page":"5939","DOI":"10.2147\/CMAR.S209194","article-title":"Comparison of short-term and survival outcomes for transanal natural orifice specimen extraction with conventional mini-laparotomy after laparoscopic anterior resection for colorectal cancer","volume":"11","author":"Zhou","year":"2019","journal-title":"Cancer Manag Res"},{"key":"B36","doi-asserted-by":"publisher","first-page":"122","DOI":"10.12998\/wjcc.v7.i2.122","article-title":"Short-term efficacy of natural orifice specimen extraction surgery for low rectal cancer","volume":"7","author":"Hu","year":"2019","journal-title":"World J Clin Cases"},{"key":"B37","doi-asserted-by":"publisher","first-page":"1119","DOI":"10.1007\/s00384-014-1950-7","article-title":"Totally laparoscopic resection with natural orifice specimen extraction (NOSE) has more advantages comparing with laparoscopic-assisted resection for selected patients with sigmoid colon or rectal cancer","volume":"29","author":"Xingmao","year":"2014","journal-title":"Int J Colorectal Dis"},{"key":"B38","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1007\/s00464-020-08260-6","article-title":"The safety and efficacy of laparoscopic surgery versus laparoscopic NOSE for sigmoid and rectal cancer","volume":"36","author":"Xu","year":"2022","journal-title":"Surg Endosc"},{"key":"B39","doi-asserted-by":"publisher","first-page":"345","DOI":"10.4103\/jmas.JMAS_182_18","article-title":"A case of vaginal recurrence following laparoscopic left-sided colon cancer resection combined with transvaginal specimen extraction","volume":"15","author":"G\u00fcndo\u011fan","year":"2019","journal-title":"J Minim Access Surg"},{"key":"B40","doi-asserted-by":"publisher","first-page":"26","DOI":"10.4174\/astr.2018.94.1.26","article-title":"Long-term outcomes after natural orifice specimen extraction versus conventional laparoscopy-assisted surgery for rectal cancer: a matched case-control study","volume":"94","author":"Park","year":"2018","journal-title":"Ann Surg Treat Res"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1716425\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T07:04:43Z","timestamp":1772003083000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1716425\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,25]]},"references-count":40,"alternative-id":["10.3389\/fsurg.2026.1716425"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2026.1716425","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,25]]},"article-number":"1716425"}}