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

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.