To promote the standardized and safe implementation of day surgery for colorectal cancer in China, the Colorectal Cancer Committee of the Chinese Anti-Cancer Association and other organizations convened experts to develop this consensus by integrating domestic and international literature and clinical practice. The consensus was developed in accordance with international standards for guideline development and the GRADE evidence grading methodology, and recommendations were formulated through expert discussion, covering the definition of day surgery, team and ward development, patient selection, perioperative management, discharge criteria, and post-discharge follow-up. The consensus emphasizes that day surgery for colorectal cancer should be carried out under strict patient selection, standardized procedures, and multidisciplinary collaboration, so as to ensure the quality of care and patient safety and to provide a reference for relevant healthcare institutions.

Colorectal cancer is one of the most common malignant gastrointestinal tumors in China, and surgery remains its primary treatment modality. With the rapid development of laparoscopy and various novel surgical approaches, staplers are being increasingly used in digestive tract reconstruction during colorectal surgery. However, there is still a lack of unified standards for the scientific selection and standardized use of stapling instruments. To address this, the Colorectal Cancer Committee of the China Anti-Cancer Association organized domestic experts in relevant fields to formulate this consensus. The consensus systematically elaborates the standardized procedures for bowel transection, anastomosis, and reconstruction in colorectal cancer surgery from three dimensions: preoperative assessment of systemic conditions and local tissues, standards for bowel transection and anastomosis, and selection and usage specifications for staplers. It covers core contents including optimization of perioperative systemic status, assessment of local tissue blood supply and tension, tumor margin criteria, selection of anastomotic methods, intraoperative quality evaluation of the anastomosis, indications and techniques for hand-sewn reinforcement suturing, principles for selecting stapler types and cartridge sizes, and standardized operating techniques for powered staplers, forming a total of 9 recommendations. This consensus aims to provide evidence-based guidance for the standardized application of staplers in colorectal surgery, so as to reduce the risk of postoperative complications such as anastomotic leakage, bleeding, and stricture, and to improve surgical safety.

Natural orifice specimen extraction surgery (NOSES) is a significant technological innovation in the field of minimally invasive surgery, hailed as “the minimally invasive surgery of minimally invasive surgeris”. By eliminating the need for an auxiliary abdominal wall incision for specimen extraction, NOSES may reduce the risks of incision-related pain, infection and incisional hernia, and facilitate postoperative recovery. Some studies have also reported advantages in psychological well-being and quality of life. From the novel perspective of the “abdominal wall organ theory”, this article systematically elaborates on the value of NOSES in preserving the structural integrity of the abdominal wall and protecting the function of the abdominal wall organ, and discusses its future directions under the concept of “minimally invasive surgery with organ protection (MIS-OP)”.

To compare the perioperative and long-term oncological outcomes of natural orifice specimen extraction surgery (NOSES) and conventional laparoscopic-assisted surgery (CLAS) for left-sided colorectal cancer.

This retrospective cohort study included patients with left-sided colorectal cancer who underwent NOSES or CLAS between January 2017 and December 2021. Propensity score matching (PSM) was performed at a 1:1 ratio, with 48 patients in each group. Perioperative outcomes, postoperative recovery, complications, pathological outcomes, and long-term oncological outcomes were compared. Disease-free survival (DFS) and overall survival (OS) were analyzed using the Kaplan-Meier method.

NOSES was associated with less intraoperative blood loss and faster postoperative recovery, as well as reduced postoperative pain and improved cosmetic satisfaction. No significant differences were observed in postoperative complications, infection rates, or main pathological outcomes. During a median follow-up of 60 months, recurrence occurred in 3 patients in the NOSES group and 8 in the CLAS group (P=0.109). The 5-year DFS rates were 93.7% and 83.3%, respectively (P=0.114).

NOSES is a feasible alternative to conventional laparoscopic surgery for left-sided colorectal cancer, offering improved postoperative recovery and cosmetic outcomes without an apparent adverse impact on long-term oncological outcomes. However, further validation in prospective, large-scale, multicenter clinical studies is warranted.

To compare the effects of a single vaginal preparation on the day before surgery (1-day group) and daily vaginal preparation on days 3, 2, and 1 before surgery (3-day group) on short-term outcomes of colorectal cancer surgery with transvaginal specimen extraction.

This exploratory retrospective cohort included 125 patients who underwent colorectal cancer surgery with transvaginal specimen extraction at the Cancer Hospital, Chinese Academy of Medical Sciences, from 2020 to 2025 were retrospectively included, comprising 53 patients in the 1-day group and 72 in the 3-day group. Vaginal antisepsis on the day of surgery and perioperative management were identical in the two groups. Preoperative characteristics, intraoperative and pathological indicators, postoperative recovery, and complications within 30 days were compared.

No statistically significant differences were found between the 1-day and 3-day groups in operative time (141.0 vs. 134.5 min, U=1 788.5, P=0.552), lymph-node yield (24.0 vs. 24.0 nodes, U=1 818.0, P=0.654), time to first postoperative flatus (2 vs. 2 days, U=1 898.0, P=0.954), or postoperative hospital stay (6 vs. 6 days, U=1 855.0, P=0.783). Infection-related complications occurred in 5/53 (9.4%) vs. 7/72 (9.7%) patients (P=1.000), early fever in 7/53 (13.2%) vs. 9/72 (12.5%) patients (P=1.000), and vaginal complications in 1/53 (1.9%) vs. 0/72 (0.0%) patients (P=0.424); none of these comparisons showed a statistically significant difference. The absolute risk difference for infection-related complications (1-day minus 3-day group) was −0.29 percentage points (95% CI: −10.76~11.60), and the odds ratio was 0.97 (95% CI: 0.23~3.79).

No statistically significant differences were observed between 1-day and 3-day vaginal preparation in operative measures, pathological quality, postoperative recovery, or short-term infectious outcomes. With standardized surgical procedures and perioperative management, vaginal preparation on the day before surgery may be considered as an option to simplify the preoperative pathway for colorectal cancer surgery with transvaginal specimen extraction.

To compare the perioperative indicators, postoperative recovery, complications and short-term follow-up outcomes between natural orifice specimen extraction surgery (NOSES) type I-A and conventional laparoscopic surgery for low rectal cancer, and to evaluate its short-term clinical benefits and safety.

Clinical data of 114 patients who underwent either of the two surgical procedures for low rectal cancer between January 2025 and June 2026 were retrospectively collected (57 cases in each group). Perioperative indicators, postoperative pathological features, postoperative complications, postoperative numerical rating scale (NRS) pain scores, postoperative low anterior resection syndrome (LARS) scores and short-term recurrence were compared between the two groups.

Compared with the conventional laparoscopic group, the NOSES type I-A group had shorter operation time [(143.98±41.84) min vs. (162.81±36.28) min], lower ileostomy rate (29.8% vs. 49.1%), lower hospitalization cost, lower NRS pain score on postoperative day 1 and lower incidence of poor wound healing (all P＜0.05); however, postoperative hospital stay was longer [12 (8.5, 14) d vs. 9 (8, 13) d, P＜0.05]. There were no significant differences in overall postoperative complications, anastomotic leakage, LARS scores, distal resection margin or short-term recurrence between the two groups (all P＞0.05).

NOSES type I-A is safe and feasible for the treatment of low rectal cancer, and can shorten operation time, reduce ileostomy rate and hospitalization cost, alleviate postoperative pain and reduce poor wound healing, without increasing anastomotic leakage, other complications or short-term recurrence. Long-term oncological outcomes warrant further follow-up.

To evaluate the clinical utility of a modified anvil placement technique in laparoscopic resection of low rectal cancer with transanal eversion and specimen extraction without an auxiliary abdominal incision (NOSES type Ⅰ, technique B).

Consecutive patients with low rectal cancer who underwent NOSES type I, procedure B, using either of two anvil placement techniques at the Department of Colorectal and Anal Surgery, the First Affiliated Hospital of Zhengzhou University, between January 2021 and September 2023 were retrospectively identified. Of the 60 patients screened, 4 were excluded because of incomplete data, leaving 56 patients for analysis. Patients were categorized according to the anvil placement technique used into an observation group (modified extracorporeal anvil placement, n=29) and a control group (conventional intracorporeal anvil placement, n=27). In the modified group, the technique previously developed by our team was performed as follows: after total mesorectal excision and adequate mobilization of the proximal sigmoid colon, the rectal stump was everted through the anus, and distal transection was performed under direct vision. The proximal sigmoid colon was then exteriorized transanally, allowing anvil insertion and fixation with a purse-string suture under direct vision. The colon was subsequently returned to the abdominal cavity, and a circular stapled anastomosis was completed. In the conventional group, the anvil was inserted intracorporeally through an incision in the proximal sigmoid stump. Anvil placement time, perioperative outcomes, 30-day complications, pathological outcomes, and oncological follow-up outcomes were compared between groups.

The overall postoperative complication rate was significantly lower in the modified group than in the conventional group [3.4% (1/29) vs. 22.2% (6/27); P=0.048]. Anvil placement time was also significantly shorter in the modified group [4.7 (2.0, 6.0) vs. 8.0 (5.0, 10.0) min; Z=4.89, P＜0.01]. Operative time (157.0 vs. 173.0 min) and intraoperative blood loss (50.0 vs. 50.0 mL) did not differ significantly between groups. No significant differences were observed in time to first flatus, first bowel movement, resumption of oral intake, or ambulation. Lymph node yield, resection margins, and specimen integrity were comparable between groups. At a median follow-up of 42.2 months, the 3-year overall survival rates were 93.1% and 88.9%, and the 3-year disease-free survival rates were 96.6% and 92.6% in the modified and conventional groups, respectively; neither difference was statistically significant.

In selected patients with low rectal cancer undergoing NOSES type Ⅰ technique B, modified extracorporeal anvil placement showed technical convenience and was associated with a shorter anvil placement/fixation time and a lower 30-day postoperative complication rate in this study. Its safety and potential benefits require confirmation in prospective, multicenter studies with larger samples.

Natural orifice specimen extraction surgery (NOSES) enables abdominal wall auxiliary-incision-free resection. Transvaginal natural-orifice specimen extraction surgery (Tv-NOSES) is mainly used in female patients with colorectal cancer, which can overcome the limitations of transanal NOSES in the removal of large volume specimens. The operation is limited by gender, specific complications and insufficient high-level evidence, and the clinical promotion is still controversial. A literature search was conducted to collect domestic and international clinical studies regarding transvaginal natural-orifice specimen extraction surgery (Tv-NOSES) for colorectal cancer published from 2014 to 2026. This narrative review summarizes evidence from the perspectives of technical evolution, key surgical procedural points, indications and contraindications, short-term perioperative efficacy, oncological safety, procedure-specific complications, existing challenges and future research directions.Tv-NOSES confers minimally-invasive benefits in strictly screened female patients with colorectal cancer, which can reduce abdominal incision-related complications, but there are specific risks such as pelvic infection, rectovaginal fistula, and vaginal incision-related injury. Currently, high-quality multicenter randomized controlled trials are lacking, and available evidence is mostly derived from single-center retrospective cohort studies. Clinical practice should strictly comply with relevant guidelines, prioritize oncological radicality, optimize preoperative assessment, and obtain adequate informed consent. Future high-quality clinical investigations with unified outcome measures are warranted to further clarify the genuine benefit-risk profile of Tv-NOSES and facilitate its standardized and individualized application.

Invasion and metastasis of colorectal cancer are the primary causes of poor prognosis, postoperative recurrence and death in patients. The current intervention methods (such as chemotherapy) are difficult to meet clinical demand due to significant toxic and side effects. Based on holistic concept and differential treatment, traditional Chinese medicine follows different therapeutic principles, including strengthening body resistance and eliminating evil, clearing heat and removing toxicity, invigorating spleen and kidney, activating blood and dissolving stasis, and it demonstrates unique value in inhibiting the invasion and metastasis of colorectal cancer. The pathways of Wnt/β-catenin, phosphatidylinositol-3 kinase/protein kinase B (PI3K/Akt), Janus kinase 2/signal transducer and activator of transcription 3 (JAK2/STAT3), nuclear factor-κB (NF-κB) and vascular endothelial growth factor (VEGF) are core signal networks to regulate invasion and metastasis of colorectal cancer. This article will systematically review the research progress on Chinese medicine compounds and monomer inhibiting colorectal cancer invasion and metastasis by regulating the above-mentioned signaling pathways in recent years, and highlight the integration that overall action mechanism of traditional Chinese medicine is shifting from the traditional single-pathway regulation model to a multi-pathway network so as to provide the basis for TCM prevention and treatment of colorectal cancer.

Colorectal cancer peritoneal metastasis (CRCPM) is often accompanied by ascites, abdominal pain and nutritional decline. Measurable lesions on imaging do not always correspond to the patient’s symptoms; therefore, treatment needs to consider both systemic disease and local intraperitoneal problems. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) delivers aerosolized chemotherapeutic agents into the abdominal cavity under pneumoperitoneum, allowing drug deposition on the peritoneal surface and exposure of superficial lesions. Recent studies suggest that PIPAC may be used for symptom control, repeated biopsy-based assessment of peritoneal disease and conversion treatment in selected patients. However, current evidence mainly comes from early-phase trials, single-arm cohorts and retrospective studies, with considerable heterogeneity in patient selection and combined regimens. This review summarizes studies of PIPAC combined with systemic chemotherapy, targeted therapy and CRS+HIPEC, and discusses the potential role of PIPAC in the multidisciplinary treatment of CRCPM.

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.

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.

This report presents the clinical course of a 61-year-old man with rectal cancer positive for extramural vascular invasion (EMVI). Preoperative MRI suggested cT₃N₁ disease with positive EMVI, while CT did not show distant metastasis. Radical surgery in July 2025 revealed pT₃N_1b disease with vascular invasion, perineural invasion, tumor deposits, and high-grade tumor budding. Chemotherapy was postponed because of postoperative fatigue, poor intake, and reduced performance status. During reassessment in September 2025, a small lesion was found in the left liver. Partial hepatectomy and ileostomy closure were performed, and intraoperative exploration also identified a peritoneal nodule near the splenic flexure. Pathology confirmed colorectal metastases in both lesions, and the stage was revised to pT₃N_1bM_1c. Next-generation sequencing showed KRAS p.G13D mutation and microsatellite stable (MSS) status, and immunohistochemistry indicated proficient mismatch repair (pMMR). The patient subsequently received 8 cycles of capecitabine and oxaliplatin (CAPEOX) plus bevacizumab, with no definite progression on imaging at the eighth cycle on May 26, 2026. This case indicates that negative routine CT findings do not fully exclude small-volume liver or peritoneal metastases in rectal cancer with MRI-detected EMVI. Careful intraoperative exploration and molecular testing may help refine staging and guide subsequent treatment.

With the increasing maturity of laparoscopic techniques in colorectal cancer surgery, minimizing peritoneal and abdominal wall trauma, alleviating postoperative pain and surgical site complications, and seeking safer and more effective minimally invasive approaches have become important research directions in colorectal surgery. To explore the safety and feasibility of a retroperitoneal approach combined with natural orifice specimen extraction surgery (NOSES) for rectosigmoid cancer, this study reports a case of a female patient with rectosigmoid adenocarcinoma who successfully underwent D3 lymph node dissection (Japanese Colorectal Cancer Society standard, dissection to the central lymph nodes) and radical resection surgery using a combination of retroperitoneal approach and transrectal specimen extraction. The procedure was successfully completed, and the patient recovered well postoperatively. There were no perioperative complications. Preliminary results indicated that the combined retroperitoneal approach and NOSES Ⅵ technique for rectosigmoid cancer was technically feasible and theoretically held the potential to integrate the advantages of both minimally invasive techniques. However further case validation is needed.