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

Abstract

Background

Gastric cancer (GC) remains a major global health burden, and minimally invasive approaches have become a primary focus in surgical oncology. Natural orifice specimen extraction surgery (NOSES) for GC integrates laparoscopic radical gastrectomy with specimen retrieval via natural orifices, aiming to minimize abdominal wall trauma while ensuring oncologic safety.

Methods

This guideline was developed through a comprehensive literature review, multidisciplinary expert panel discussions, and synthesis of accumulated clinical experience in GC-NOSES. The recommendations address operative platforms, aseptic and tumor-free techniques, digestive tract reconstruction, and procedure-specific steps. Emphasis was placed on perioperative safety, oncologic principles, and standardization of surgical procedures.

Results

Although most existing studies are small-scale, single-center, and retrospective, accumulating data suggest that GC-NOSES offers comparable oncological outcomes to conventional laparoscopic gastrectomy while reducing postoperative pain, accelerating gastrointestinal recovery, shortening hospital stay, and improving cosmetic satisfaction.

Conclusion

GC-NOSES is a promising minimally invasive option with potential benefits in postoperative recovery and quality of life. Standardized procedures, structured training, and high-quality multicenter studies are essential to further confirm its safety, refine indications, and promote global implementation.