ArticleSurgical endoscopy2026
Transanal natural orifice specimen extraction for restorative minimally invasive total mesorectal excision, enabled by transanal transection and single-stapled anastomosis: a propensity score-matched study of wound complications and postoperative pain.
Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
BACKGROUND AND
aimsIn restorative total mesorectal excision (TME), transanal rectal transection and single-stapled anastomosis (TTSS) provide an access route that enables transanal NOSE before anastomosis. We evaluated wound complications and postoperative pain associated with SS-NOSE strategy compared with conventional double-stapled anastomosis and transabdominal specimen extraction.
methodsThis single-center, retrospective, propensity score-matched (PSM) cohort study included patients undergoing TME for low rectal cancer, as defined by the Low Rectal Cancer Development Program (LOREC), between January 2017 and January 2023. The primary endpoint was the 30-day wound complications rate in the control and in the SS-NOSE groups. Secondary endpoints included differences in postoperative pain at 24, 48, and 72 h, measured using the Numerical Rating Scale (NRS), and the need for opioid rescue therapy during hospitalization.
resultsThe unmatched analysis included 303 patients (104 SS-NOSE and 199 controls). After PSM, 208 patients were compared. The 30-day wound complications was lower in the SS-NOSE group (2.9% vs. 14.4%; p = 0.003). SS-NOSE was an independent protective factors against wound complications at multivariable analysis (OR: 0.17; 95% CI 0.05 to 0.62; p = 0.007). Postoperative pain was improved at 24 and 48 h (0 [0-1] vs. 1 [0-3]; p = 0.005; 0 [0-1] vs 0 [0-2]; p< 0.0001) and comparable at 72 h after surgery (0 [0-0] vs. 0 [0-0]; p = 0.583). No significant difference was found in opioid rescue therapy requirements and overall postoperative complications.
conclusionTransanal NOSE, enabled by TTSS, was associated with fewer wound complications and lower early postoperative pain compared with conventional double-stapled anastomosis and transabdominal specimen extraction following restorative TME for low rectal cancer.
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