To compare the perioperative efficacy and postoperative anal function of natural orifice specimen extraction surgery (NOSES) versus minimal laparotomy (Mini-Lapar) in treating rectal cancer in middle-aged and elderly patients.

Retrospective analysis of data from 124 rectal cancer surgery patients at Affiliated Hospital of Inner Mongolia Medical University between June 2020 and September 2023 (62 in the NOSES group and 62 in the Mini-Lapar group). The preoperative baseline data, perioperative information, pathological data, postoperative inflammatory markers, and Wexner, Vaizey, and LARS scores within one year were compared to evaluate anal function.

The first postoperative gas release time (t=−3.958, P<0.001), defecation time (t=−3.403, P<0.001), intake of liquid diet time (t=−3.232, P=0.001), and time out of bed (t=−2.648, P=0.005) in the study group(NOSES group) were all earlier than those in the control group(Mini-Lapar group) (all P<0.05). The postoperative VAS scores in the study group were lower (all P<0.05), and the hospital stay was shorter (t=−3.936, P<0.001). On the second day after surgery (t=2.107, P=0.039) and the third day, the body temperature (t=2.618, P=0.011) in the study group was higher than that in the control group. On the first day (t=3.286, P=0.002) and the third day, the neutrophil levels (t=2.227, P=0.030), as well as on the third day (t=2.584, P=0.012) and the fifth day, the CRP levels (t=2.094, P=0.040) were also higher in the study group than in the control group. Within 6 months after the operation, the overall anal function of the study group was worse than that of the control group (all P<0.05). At one year after the operation, there was no difference between the two groups (all P>0.05).

NOSES can accelerate the postoperative recovery of middle-aged and elderly patients with rectal cancer, and does not affect the long-term anal function after surgery. It is worth further promotion in middle-aged and elderly patients with rectal cancer.