Colorectal cancer is one of the most common malignant tumors worldwide, with surgical resection remaining the cornerstone of curative treatment. Although laparoscopic surgery has significantly advanced the development of minimally invasive treatments, the traditional abdominal wall-assisted incision still carries risks of postoperative pain, incisional hernia, and infection. Against this backdrop, natural orifice specimen extraction surgery (NOSES), which eliminates the need for abdominal wall incisions, has emerged as a research focal focus in colorectal cancer surgery. Through systematic exploration and technological innovation led by Chinese scholars such as professor Wang Xishan, NOSES in China has transitioned from its nascent phase to a relatively mature stage, significantly improving postoperative quality of life for patients. However, this surgical approach still faces two critical challenges: aseptic and tumor-free safety. This review aims to systematically summarize the research progress on aseptic and tumor-free issues in NOSES for colorectal cancer, integrates global technical practice variations and innovations in intelligent assistive devices, and proposes strategies for technical standardization and clinical translation.