DESIGN: Health efficiency analysis using data envelopment analysis (DEA) and stochastic frontier approach analysis.
SETTING: Health systems in China and ASEAN countries.
METHODS: DEA-Malmquist model and SFA model were used to analyse the health system efficiency among China and ASEAN countries, and the Tobit regression model was employed to analyse the factors affecting the efficiency of health system among these countries.
RESULTS: In 2020, the average technical efficiency, pure technical efficiency and scale efficiency of China and 10 ASEAN countries' health systems were 0.700, 1 and 0.701, respectively. The average total factor productivity (TFP) index of the health systems in 11 countries from 2015 to 2020 was 0.962, with a decrease of 1.4%, among which the average technical efficiency index was 1.016, and the average technical progress efficiency index was 0.947. In the past 6 years, the TFP index of the health system in Malaysia was higher than 1, while the TFP index of other countries was lower than 1. The cost efficiency among China and ASEAN countries was relatively high and stable. The per capita gross domestic product (current US$) and the urban population have significant effects on the efficiency of health systems.
CONCLUSIONS: Health systems inefficiency is existing in China and the majority ASEAN countries. However, the lower/middle-income countries outperformed high-income countries. Technical efficiency is the key to improve the TFP of health systems. It is suggested that China and ASEAN countries should enhance scale efficiency, accelerate technological progress and strengthen regional health cooperation according to their respective situations.
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.