经自然腔道取标本手术（NOSES）可避免腹壁辅助取标本切口，但男性右半结肠肿瘤合并上腹部第二原发肿瘤时，标本转运及经直肠取出更具挑战。本文报告1例59岁男性，因便血1个月余就诊。结肠镜示横结肠近肝曲环周肿物，活检为中分化腺癌；增强CT同时发现胃大弯侧3.2 cm×2.3 cm外生性肿物。患者接受全腹腔镜胃肿瘤局部切除联合右半结肠癌根治术、回肠-横结肠腔内吻合，并经直肠切口分步取出保护袋内标本。手术时间136 min，术中出血约20 mL。术后病理示结肠中分化腺癌pT4aN0（0/32），胃肿瘤为低危胃肠道间质瘤。患者术后第五天出院，随访3个月时肛门功能正常。该病例提示，在严格评估标本体积和取出路径并遵循无菌、无瘤原则的前提下，同期联合切除及经直肠取标本具有技术可行性，但其适应证边界和远期安全性仍需更多证据。

Natural orifice specimen extraction surgery (NOSES) avoids an auxiliary abdominal incision, but transrectal retrieval is technically demanding in a male patient with right-sided colon cancer and a synchronous upper-abdominal neoplasm. A 59-year-old man presented with hematochezia for more than one month. Colonoscopy showed a circumferential lesion near the hepatic flexure, and biopsy indicated moderately differentiated adenocarcinoma. Contrast-enhanced computed tomography also revealed a 3.2 cm×2.3 cm exophytic mass at the greater curvature of the stomach. Totally laparoscopic gastric wedge resection and radical right hemicolectomy with intracorporeal ileocolic anastomosis were performed. Both protected specimens were retrieved stepwise through a rectal incision. The operative time was 136 min, and blood loss was approximately 20 mL. Pathology demonstrated pT4aN0 colon adenocarcinoma (0/32 lymph nodes) and a low-risk gastric gastrointestinal stromal tumor. The patient was discharged on postoperative day 5 and had normal anal function at the three-month follow-up. This case supports the technical feasibility of synchronous resection with transrectal specimen extraction after strict assessment of specimen size and extraction route; broader indications and long-term safety require further evidence.