总结右半结肠癌同期合并不同部位第二原发肿瘤行经自然腔道取标本手术（NOSES）的技术经验，分析联合切除条件下的取标本路径选择。

采用单中心回顾性病例系列设计，描述2026年7月接受同期全腹腔镜联合切除及NOSES的3例患者资料。第二原发肿瘤分别为上段直肠癌、具有恶性潜能的胃肠道间质瘤和下段直肠癌。记录临床病理特征、消化道重建、取标本通道、住院期恢复及术后30 d内并发症。

P1经联合直肠切除形成的可利用直肠残端，经肛门依次取出两份标本；P2经直肠前壁切口，经肛门分次取出胃及右半结肠标本；P3经肛门外翻切除直肠病灶，经阴道取出右半结肠标本。手术时间为136 min~242 min，术中出血量为20 mL~30 mL，术后住院时间为5 d~7 d。3例均完成预定取标本操作，未增加腹壁取标本切口，术后30 d内均未发生Clavien-Dindo分级≥Ⅱ级的并发症，术后恢复良好。

本组病例展示了同期联合切除中不同NOSES取标本路径的技术实施过程。路径选择需结合肿瘤切除方案、可利用通道及标本条件逐一评估。本组短期观察结果尚不足以确立不同路径的安全性或功能获益，远期肿瘤学结局仍需随访。

To describe the technical experience and specimen extraction decisions in patients undergoing natural orifice specimen extraction surgery (NOSES) for right colon cancer with synchronous second primary tumors.

This single-center retrospective case series included three patients who underwent simultaneous totally laparoscopic resection and NOSES in July 2026. The second primary tumors were upper rectal cancer, a gastric gastrointestinal stromal tumor with malignant potential, and lower rectal cancer. Clinicopathological findings, reconstruction, extraction routes, in-hospital recovery, and complications within 30 days after surgery were reviewed.

In P1, both specimens were removed transanally through the rectal stump created during rectal resection. In P2, the gastric and right-colon specimens were removed transanally through an anterior rectotomy. In P3, the rectal lesion was resected by transanal eversion, and the right-colon specimen was extracted transvaginally. Operative time ranged from 136 to 242 min, blood loss from 20 to 30 mL, and postoperative hospital stay from 5 to 7 days. Extraction was completed without an additional abdominal extraction incision in all three patients, and no Clavien-Dindo grade II or higher complications occurred within 30 postoperative days. All three patients recovered well.

These cases illustrate the technical implementation of different NOSES extraction routes during simultaneous resection. Decisions should account for the oncological resection plan, usable access, and specimen characteristics. These short-term observations do not establish the safety or functional benefit of individual routes; long-term oncological outcomes require further follow-up.