International guideline on natural orifice specimen extraction surgery (NOSES) for colorectal cancer (2025 version)

Liu Z 1 , Wang Z 2 , Yang L 3 , Ma Z 1 , Wang S 4 , Zhou H 2 Show all authors , Tang L 5 , Wei B 6 , Yu S 7 , Feng Q 8 , Tang Q 9 , Liu R 10 , Wang F 11 , Wang G 9 , Zhou C 12 , Niu W 12 , Wei Y 13 , Sun X 14 , Yao H 15 , Peng J 16 , Ma D 17 , Hu J 18 , Zheng Y 19 , Jiang B 20 , Han F 21 , Xiong Z 22 , Mo X 23 , Li T 24 , He Q 25 , Liu Z 26 , Li Y 27 , Zhang T 28 , Kang L 29 , Wang Z 30 , Ding K 7 , Zhang W 31 , Tsarkov P 32 , Tulina I 32 , Artur I 33 , Efetov S 34 , Tzu-Liang Chen W 35 , Ming-Yin Shen M 36 , Kayaalp C 37 , Kim SH 38 , Lee SH 39 , Lee WY 40 , Min BS 41 , Kim S 42 , Khan J 43 , Seow-En I 44 , Xuan Hung T 45 , Docimo L 46 , Nishimura A 47 , Uehara K 48 , Saklani A 49 , Simon NSM 50 , William MCS 51 , Luo G 52 , Parvaiz A 53 , Mongardini FM 46 , Shaw D 54 , Dulskas A 55 , Franchini Melani AG 56 , Forgione A 57 , Naeem M 58 , Mah JJ 59 , Wang X 60

Affiliations 

  • 1 Gastrointestinal Cancer Center, Beijing Arion Cancer Center, Beijing, China
  • 2 Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
  • 3 The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing, China
  • 4 Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
  • 5 Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, Guangxi, China
  • 6 Department of Gastrointestinal Surgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
  • 7 Department of Colorectal Surgery and Oncology (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education), The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
  • 8 Jiangyin People's Hospital Affiliated to Nantong University, Wuxi, Jiangsu, China
  • 9 The 2nd Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
  • 10 Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
  • 11 Yuncheng Central Hospital, Yuncheng, Shanxi, China
  • 12 The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
  • 13 Department of General Surgery, Huadong Hospital Fudan University, Shanghai, China
  • 14 First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
  • 15 Department of General Surgery, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
  • 16 Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
  • 17 Department of General Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
  • 18 Department of Colorectal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
  • 19 Department of Gastrointestinal Surgery, Sichuan Cancer Hospital, Chengdu, China
  • 20 Department of Colorectal Surgery, Shanxi Provincial Cancer Hospital, Taiyuan, China
  • 21 Department of Gastrointestinal Surgery, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China
  • 22 Department of Gastrointestinal Surgery, Hubei Clinical Medical Research Center of Colorectal Cancer, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, China
  • 23 Division of Colorectal and Anal Surgery, Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
  • 24 Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
  • 25 Department of Gastrointestinal Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
  • 26 General Surgery of Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
  • 27 Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
  • 28 Department of General Surgery, The Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
  • 29 Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
  • 30 Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University, 155 N, Nanjing Street, Shenyang, Liaoning, China
  • 31 Department of Colorectal Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
  • 32 I.M. SechenovFirstMoscow StateMedicalUniversity(Sechenov University), Clinic of Coloproctology and Minimally Invasive Surgery, Moscow, Russia
  • 33 Bashkir State Medical University, Ufa, Russia
  • 34 Department of Faculty Surgery No. 2, I. M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
  • 35 School of Medicine, Department of Surgery, China Medical University, Taichung, Taiwan, Republic of China
  • 36 Department of Colorectal Surgery, China Medical University Hsinchu Hospital, Hsinchu, Taiwan, Republic of China
  • 37 Private General Surgery Clinic, Istanbul, Turkey; Istanbul Atlas University, Istanbul, Turkey
  • 38 Department of Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, 50603, Malaysia
  • 39 Department of Surgery, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, South Korea
  • 40 Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
  • 41 Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
  • 42 IRCAD China, Wuxi, Jiangsu, China
  • 43 Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
  • 44 Department of Colorectal Surgery, Singapore General Hospital, Outram Road, Singapore
  • 45 University of Medicine & Pharmacy at Ho Chi Minh City, Viet Nam
  • 46 Department of General, Mininvasive, Oncologic and Obesity Surgery - University of Campania Luigi Vanvitelli, Naples, Italy
  • 47 Department of Surgery, Institute of Gastroenterology Nagaoka Chuo General Hospital, Niigata, Japan
  • 48 Department of Gastroenterological Surgery, Nippon Medical School, Tokyo, Japan
  • 49 Division of Colorectal and Robotic Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
  • 50 Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China
  • 51 Minimally Invasive Surgery Centre & Endoscopy Centre, Hong Kong Special Administrative Region of China
  • 52 Kiang Wu Hospital, Macao Special Administrative Region of China
  • 53 Digestive unit, Champalimaud Foundation, Lisbon, Portugal
  • 54 Colorectal Surgery Associates, Kansas City University, Kansas, MO, United States
  • 55 Department of Surgery, National Cancer Institute (Lithuania), Vilnius, Lithuania
  • 56 IRCAD America Latina, Surgical Staff Americas Medical Services, Rio de Janeiro, Brazil
  • 57 Advanced International Mini-invasive Surgery - AIMS Academy, Milan, Italy
  • 58 Department of Surgery, Khyber Teaching Hospital, Peshawar, Pakistan
  • 59 Department of Surgery, Queen Elizabeth Hospital, Kota Kinabalu, Malaysia
  • 60 Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Electronic address: wxshan1208@126.com
Eur J Surg Oncol, 2026 Nov;52(11):112105.
PMID: 42731257 DOI: 10.1016/j.ejso.2026.112105

Abstract

PURPOSE: Natural orifice specimen extraction surgery (NOSES) has emerged as a minimally invasive technique in colorectal cancer treatment, offering improved postoperative recovery and cosmetic outcomes. Building upon previous editions, this third edition guideline aims to update and refine technical classifications, indications, and procedural standards based on the latest evidence and accumulated clinical experience.

METHODS: This guideline was jointly developed by the Colorectal Cancer Committee of the China Anti-Cancer Association and the International Alliance of NOSES, incorporating recent multicenter data, consensus discussions, and advancements in laparoscopic and robotic techniques. This updated guideline was developed through an expert consensus-based revision process informed by comprehensive literature review and available multicenter clinical evidence, and was finalized after iterative discussion and approval by the guideline steering committee.

RESULTS: This edition provides targeted updates from the previous version, including refined recommendations on preoperative assessment and acknowledgment of robotic assistance. Adjustments to surgical classifications, indications, and procedural descriptions have also been made to enhance clarity and clinical applicability.

CONCLUSION: This updated guideline provides a structured and practical reference for colorectal NOSES procedures, supporting wider adoption and continued surgical advancement.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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