A randomized controlled trial comparing robotic NOSES versus robotic TME for Mid-rectal cancer: short-term oncological and perioperative outcomes

Clinical Snapshot

Key Findings

• P Value: P = 0.02 for flatus time, P = 0.041 for diet resumption, P = 0.045 for wound complications

• Effect Size: 5-hour reduction in time to first flatus, 5-hour reduction in time to liquid diet resumption

• Primary Outcome: Overall complication rates were similar (R-NOSES 13.0% vs R-TME 15.5%)

• Nnt Or Sensitivity: Number needed to treat to prevent one wound complication approximately 18 patients

• Confidence Interval: Not reported

Clinical Application

Requires advanced robotic surgical expertise and natural orifice extraction capabilities Limited applicability given few Australian centres have robotic colorectal programs; would require significant training and infrastructure investment Selected patients with mid-rectal cancer suitable for robotic surgery in centres with appropriate expertise

Abstract

This randomized study compared perioperative outcomes between robotic natural orifice specimen extraction surgery (R-NOSES) and robotic total mesorectal excision (R-TME) in participants with mid-rectal cancer. After exclusions, 71 participants in the R-TME cohort and 69 in the R-NOSES cohort were included in the final analysis, from an initial randomized cohort of 150 eligible participants (1:1 allocation). The two cohorts had comparable preoperative characteristics. Intraoperative and pathological outcomes, including blood loss, operative duration, and harvested lymph nodes, showed no notable differences. The rates of overall complication were comparable between the two groups (R-NOSES 13.0% vs. R-TME 15.5%, P = 0.679), and anastomotic leakage did not vary significantly. Conversely, the R-TME group experienced a higher rate of wound complications (5.6% vs. 0.0%, P = 0.045). Notably, the R-NOSES group demonstrated significant advantages in postoperative recovery, including shorter time to first flatus (48 vs. 53 h, P = 0.02), earlier resumption of a liquid diet (79 vs. 84 h, P = 0.041), and markedly reduced VAS pain ratings on postoperative days 1 and 3. In conclusion, for selected patients with middle rectal cancer, R-NOSES appears to be a safe and feasible alternative to R-TME, with similar short-term oncological outcomes. It may offer some benefits in terms of faster recovery, less postoperative pain, and fewer wound-related complications.Trial Registration: ClinicalTrials.gov Identifier NCT06454201.

References

1. 1.Li, T. Y., Min, F. Z., Yu, T., Luo, A. L., & Ye, S. P. (2026). A randomized controlled trial comparing robotic NOSES versus robotic TME for Mid-rectal cancer: short-term oncological and perioperative outcomes. Journal of Robotic Surgery. https://doi.org/10.3389/fendo.2022.837902