To explore the safety and feasibility of Da Vinci robot-assisted natural orifice specimen extraction surgery (NOSES) for the combined resection of rectal cancer with multiple organs.

During October 2013 to February 2021, totally 11 patients undergoing this surgery in the department of colorectal surgery, Zhongshan Hospital of Fudan University were included into presented retrospective study. The analysis content includes the patient's baseline condition, surgery condition, postoperative condition and so on.

Of the 11 patients in the whole group, included 2 males (2/11) and 9 females (9/11) with average age of (56.0±11.2) years, 8 low rectal cancer patients (8/11), 2 middle rectal cancer patients (2/11) and 1 high rectal cancer patients (1/11). One case (1/11) had diabetes mellitus, 2 cases (2/11) had hypertension and 1 case (1/11) had coronary heart disease. Whole group of patients were successfully completed robot assisted NOSES combined multiple organ resection of rectal cancer excision, which combined the uterus double appendix resection in 4 cases, combined hysterectomy in 1 case, combined the small intestine and the uterus double appendix resection in 1 case, combined lung metastases resection in 1 case, ovarian cyst resection in 1 case, cystic resection in 1 case, liver ALPPS surgery in 1 case, lobe resection in 1 case. The mean operation time was (175.5±48.2) min and the mean blood loss was (33.6±19.1) mL. No patient was transferred to laparotomy, and no intraoperative blood transfusion was found in the whole group. The upper and lower margins and circumferential margins were negative in all patients. There were no perioperative deaths. Postoperative complications occurred in 2 patients (2/11) (1 case intestinal insufficiency obstruction, 1 case pulmonary infection), all of which improved after conservative treatment. The mean postoperative exhaust time was (74.2±33.1) hours, the mean postoperative hospital stay was (5.9±0.9) days, and the mean postoperative adjuvant treatment start time was (18.3±5.4) days.Postoperative pathological TNM stages were stage Ⅱ in 2 patients (2/11), stage Ⅲ in 4 patients (4/11) and stage Ⅳ in 5 patients (5/11).

It is safe and feasible to perform robot-assisted NOSES multiple organ resection for eligible patients with rectal cancer under comprehensive evaluation.