To compare the clinical effects of transvaginal and transanal natural orifice specimen extraction surgery (NOSE) in laparoscopic radical resection of colorectal cancer (CRC) in women.

The clinical data of 112 female CRC patients from June 2023 to May 2025 were retrospectively analyzed. They were divided into the vaginal group (n=41, specimens removed through the vagina) and the anal group (n=71, specimens removed through the anus) based on different NOSE methods. The measurement data conforming to normal distribution were expressed as (±s), and independent sample t test was used; the count data were analyzed by χ² test. P<0.05 was considered statistically significant.

The operation time, postoperative hospital stay, time to first flatus, time to first defecation, and time to start liquid diet in the vaginal group were all shorter than those in the anal group (P<0.05). There were no statistically significant differences in intraoperative blood loss, lengths of proximal and distal resected intestinal segments, number of lymph nodes dissected, and complication rates between the two groups (P>0.05). Three months after surgery, the Female Sexual Function Index (FSFI) of both groups increased compared with that before surgery, and the Pelvic Floor Impact Questionnaire 7 (PFIQ-7) score and Pelvic Floor Distress Inventory 20 (PFID-20) score decreased compared with those before surgery (P<0.05), but there were no statistically significant differences in these indicators between the two groups (P>0.05).

Transvaginal specimen extraction during laparoscopic CRC resection can significantly simplify the surgical procedure, accelerate postoperative gastrointestinal function and physical recovery, without increasing the risk of pelvic floor dysfunction or complications, under the premise of ensuring the radical effect and surgical safety. It can be used as an efficient and safe specimen extraction method in laparoscopic surgery for female CRC patients.