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.