Transanal specimen extraction linked to fewer wound complications after rectal cancer surgery

Researchers conducted a single-center retrospective cohort study of patients who underwent restorative total mesorectal excision for low rectal cancer from January 2017 to January 2023. The study compared transanal natural-orifice specimen extraction enabled by transanal transection and single-stapled anastomosis (SS-NOSE) with conventional double-stapled anastomosis and transabdominal specimen extraction. Of 303 patients in the unmatched cohort, 208 were included after propensity score matching. The primary endpoint was wound complications within 30 days; secondary endpoints included pain scores and opioid rescue therapy.

After matching, wound complications occurred in 2.9% of the SS-NOSE group versus 14.4% of controls (p=0.003). SS-NOSE was also associated with lower pain scores at 24 hours (median 0 vs 1; p=0.005) and 48 hours (0 vs 0; p<0.0001). Pain scores at 72 hours, opioid rescue requirements, and overall postoperative complications did not differ significantly between groups.

The findings suggest potential short-term wound and pain benefits for this technique in selected patients undergoing restorative surgery for low rectal cancer. However, the retrospective, single-center design leaves the results vulnerable to residual confounding and limits their generalizability; comparative studies are needed before drawing conclusions about wider adoption.