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.