Anorectal function after transanal natural orifice specimen extraction for colorectal cancer: a systematic review and meta-analysis.
- 1Department of Colorectal Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
- 2Internal Medicine Residency, Singapore General Hospital, Singapore, 169608, Singapore.
- 3Department of Colorectal Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore. [email protected].
Abstract
Purpose
Natural orifice specimen extraction (NOSE) eliminates the abdominal extraction incision after minimally invasive (MIS) colorectal resection and offers favourable short-term recovery, but transanal extraction raises concerns regarding sphincter stretch and anorectal dysfunction. This review evaluated anorectal functional outcomes after transanal NOSE compared with transabdominal specimen extraction (TASE) in MIS colorectal cancer surgery.Methods
MEDLINE and EMBASE were searched from inception to August 2024 for comparative studies reporting postoperative anorectal or pelvic floor functional outcomes following transanal NOSE versus TASE. The primary outcome was anorectal continence at the postoperative interval closest to 6 months.Results
Ten retrospective cohort studies were included, of which seven (1362 patients) contributed quantitative data for meta-analysis. Three studies contributed to the pooled Wexner incontinence score analysis and four to the pooled Pelvic Floor Distress Inventory short form (PFDI-20) analysis. At the interval closest to 6 months, Wexner scores were numerically higher after transanal NOSE than TASE, but the difference was small and non-significant (MD 0.17, 95% CI - 0.01 to 0.35; p = 0.07). PFDI-20 scores did not differ between groups (MD - 0.02, 95% CI - 0.21 to 0.18; p = 0.86). Both estimates were robust in leave-one-out and overlap-adjusted analyses excluding potentially overlapping Harbin Medical University cohorts. Early differences appeared to diminish over time, with no clear separation beyond 12 months.Conclusion
Transanal NOSE was associated with a small, non-significant trend toward higher early Wexner scores after MIS colorectal cancer surgery, while broader pelvic floor symptom burden appeared comparable to TASE. The difference was of uncertain clinical significance, was robust to sensitivity analyses, and longer-term data suggested no persistent functional disadvantage.
Related
- Efficacy and Safety of Stapled Transanal Rectal Resection (STARR) for Obstructed Defecation Syndrome: A Systematic Review and Meta-Analysis of Comparative Studies
- Long-Term Recurrence After Transanal Hemorrhoidal Dearterialization Versus Excisional and Stapled Surgery for Hemorrhoidal Disease: A Systematic Review and Meta-Analysis of Studies with ≥24 Months of Follow-Up.
- Systematic Evaluation of External Anal Sphincter Fatigability in Healthy Women and Women With Fecal Incontinence: A High-Resolution Anorectal Manometric Study
- Comparative outcomes of natural orifice specimen extraction surgery versus conventional minilaparotomy-assisted specimen extraction in colorectal cancer: A single-center retrospective study.
- Robot-assisted radical surgery for colorectal cancer: technical advances, lymphadenectomy, natural orifice specimen extraction, and ongoing controversies.
BibTeX
@article{chua2026anorectal,
title = {{Anorectal function after transanal natural orifice specimen extraction for colorectal cancer: a systematic review and meta-analysis.}},
author = {Megan Wern Ee Chua and Ashley Shi Hui Lee and Prasad Palanisamy and Ian Jun Yan Wee and Isaac Seow-En},
journal = {Langenbeck's archives of surgery},
year = {2026},
month = aug,
doi = {10.1007/s00423-026-04184-2},
url = {https://europepmc.org/article/MED/42972089},
note = {CC BY},
}
RIS
TY - JOUR
TI - Anorectal function after transanal natural orifice specimen extraction for colorectal cancer: a systematic review and meta-analysis.
AU - Megan Wern Ee Chua
AU - Ashley Shi Hui Lee
AU - Prasad Palanisamy
AU - Ian Jun Yan Wee
AU - Isaac Seow-En
PY - 2026
DA - 2026/08/05
JO - Langenbeck's archives of surgery
DO - 10.1007/s00423-026-04184-2
UR - https://europepmc.org/article/MED/42972089
AB - Purpose Natural orifice specimen extraction (NOSE) eliminates the abdominal extraction incision after minimally invasive (MIS) colorectal resection and offers favourable short-term recovery, but transanal extraction raises concerns regarding sphincter stretch and anorectal dysfunction. This review evaluated anorectal functional outcomes after transanal NOSE compared with transabdominal specimen extraction (TASE) in MIS colorectal cancer surgery.Methods MEDLINE and EMBASE were searched from inception to August 2024 for comparative studies reporting postoperative anorectal or pelvic floor functional outcomes following transanal NOSE versus TASE. The primary outcome was anorectal continence at the postoperative interval closest to 6 months.Results Ten retrospective cohort studies were included, of which seven (1362 patients) contributed quantitative data for meta-analysis. Three studies contributed to the pooled Wexner incontinence score analysis and four to the pooled Pelvic Floor Distress Inventory short form (PFDI-20) analysis. At the interval closest to 6 months, Wexner scores were numerically higher after transanal NOSE than TASE, but the difference was small and non-significant (MD 0.17, 95% CI - 0.01 to 0.35; p = 0.07). PFDI-20 scores did not differ between groups (MD - 0.02, 95% CI - 0.21 to 0.18; p = 0.86). Both estimates were robust in leave-one-out and overlap-adjusted analyses excluding potentially overlapping Harbin Medical University cohorts. Early differences appeared to diminish over time, with no clear separation beyond 12 months.Conclusion Transanal NOSE was associated with a small, non-significant trend toward higher early Wexner scores after MIS colorectal cancer surgery, while broader pelvic floor symptom burden appeared comparable to TASE. The difference was of uncertain clinical significance, was robust to sensitivity analyses, and longer-term data suggested no persistent functional disadvantage.
SN - 1435-2443
SN - 1435-2451
ER -