Correspondence - A Commentary on Comparative long-term outcomes of natural oriﬁce specimen extraction surgery and conventional laparoscopic colectomy

Sep 21, 2026

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A letter to the editor provides a scholarly commentary on a comparative study of natural oriﬁce specimen extraction surgery versus conventional laparoscopic colectomy for left-sided colorectal cancer. The authors affirm the reported safety, feasibility, and benefits for cosmetic outcomes, pain reduction, faster return of gastrointestinal function, and similar long-term clinical and oncologic results. They request consideration of missing prognostic nutritional index data, lack of discussion on diabetes history, and whether both groups should follow Enhanced Recovery After Surgery (ERAS) protocols.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages2

Reading Time5 min

AccessFree to download

Letter to the Editor

Key points for consideration

Ethical approval and authorship notes

Funding, conflicts, and publication details

’Correspondence A commentary on ‘Comparative long-term outcomes of natural oriﬁce specimen extraction surgery and conventional laparoscopic colectomy for left-sided colorectal cancer: a propensity scorematched analysis’ Zechuan Wang, MDa , Qiang Hu, MDb , Fengru Zhou, MDb,* Dear Editor, We have read with interest the article published by Xu et al. [1] . This study conﬁrms that NOSES colectomy using a Cai tube for left-sided colorectal cancer is a safe and feasible option with better cosmetic results, less pain, faster recovery of gastrointestinal function, and comparable long-term clinical and oncologic outcomes to CL colectomy. This is a very important and meaningful study, as it provides us with a new surgical technique and has a signiﬁcant guiding effect on clinical practice. Although, we believe it is a very interesting topic, we would like to offer the following points for your consideration. First, the prognostic nutritional index (PNI) was not provided in the manuscript. Multiple studies have shown that the PNI is an independent risk factor for predicting postoperative complications in colorectal cancer[2]. The PNI describes a patient’s nutritional status, inﬂammatory response, and immune level, which is related to serum albumin concentration and total peripheral blood lymphocyte count. A study showed that the incidence of postoperative complications in the low PNI group was as high as 88.2%, while the incidence of postoperative complications in the high PNI group was 11.8%[3]. If the patient is at a low albumin level before surgery, postoperative complications such as anastomotic leakage, anastomotic bleeding, intestinal obstruction, abdominal infection, and pulmonary infection will increase. If the preoperative lymphocyte count is abnormal, it reﬂects a decrease in the body’s immune system, and the corresponding immune system’s recognition ability will also decrease, which may lead to tumor recurrence and metastasis. Second, in the manuscript, whether there is a history of diabetes has not been discussed. Some studies have conﬁrmed that diabetes isan independent risk factor for infectious complications after rectal cancer surgery[4]. As a risk factor for postoperative complications of rectal cancer, diabetes has many mechanisms, including the following two aspects: on the one hand, due to the disorder of glucose metabolism in diabetes patients, their tissue healing is slow, and their anti-infective ability also decreases, which prolongs the healing time of the anastomotic stoma and reduces the body’s resistance to inﬂammation, thus easily causing infection and anastomotic leakage. On the other hand, diabetes will cause changes in blood vessels throughout the body, leading to arteriosclerosis, thus reducing the blood supply capacity of the anastomosis. Therefore, patients with diabetes have a higher probability of postoperative complications. Third, in the manuscript, it was not discussed whether both groups should use Enhanced Recovery After Surgery (ERAS) protocol. An increasing number of studies have conﬁrmed that ERAS protocol can reduce the stress response of patients during surgery, reduce related complications, and thus shorten hospital stay[5]. Currently, ERAS Protocol has been widely used worldwide. Finally, we hope that the above factors can be further taken into consideration. Ethical approval Not applicable. aDepartment of Traditional Chinese Medicine, Community Health Service Center of Guali, Town of Xiaoshan and bDepartment of General Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, People ’s Republic of China Zechuan Wang and Qiang Hu have equal contributions to the article. Sponsorships or competing interests that maybe relevant to content are disclosed atthe end of this article. *Corresponding author. Address: Department of General Surgery, Tongde Hospital of Zhejiang Province, 234 Gucui road, Hangzhou 310012, People’s Republic of [China. E-mail: zfr0534@126.com](Chi

FAQs

Why do the authors emphasize the prognostic nutritional index (PNI) in the commentary?

The authors note that PNI was not provided and explain that it is an independent risk factor for predicting postoperative complications in colorectal cancer. They connect low PNI with higher postoperative complication rates and mechanisms involving nutrition, inflammation, and immune status.

How does the letter discuss diabetes as a risk factor?

The authors state that the manuscript did not discuss diabetes history and cite evidence that diabetes is an independent risk factor for infectious complications after rectal cancer surgery. They describe effects on glucose metabolism, impaired healing and immune function, and vascular changes that reduce anastomotic blood supply.

What is the requested clarification regarding ERAS protocol use?

The letter points out that it was not discussed whether both groups should use the Enhanced Recovery After Surgery (ERAS) protocol. It argues that ERAS can reduce surgical stress response, lower complications, and shorten hospital stay, and notes it is widely used.

Sep 21, 2026

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