Natural orifice specimen extraction surgery (NOSES) has attracted attention because of its minimal invasiveness. This meta-analysis compared inflammatory response profiles and infectious complications between colorectal cancer (CRC) patients treated with NOSES and those treated with conventional laparoscopy (CL). Seven medical databases were searched up to February 2024.We included studies that examined changes in the inflammatory response and outcomes in the patients after NOSES surgery. The Cochrane tool and Newcastle-Ottawa Scale (NOS) were used to evaluate the quality of the studies. Pooled standardized mean differences (SMDs) and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using either fixed- or random-effects models. Review Manager 5.4 (RevMan 5.4) and the R project were used for the meta-analysis. This meta-analysis included 22 studies. Pooled analyses revealed lower tumor necrosis factor-α (TNF-α) levels (SMD=-1.34,95% CI [-2.43, -0.25]; Z=2.40, P=0.02 and SMD =-1.49,95% CI [-2.15, -0.82]; Z=4.36, P<0.0001) and C reactive protein (CRP) levels (SMD=-0.56, 95% CI [-4.17, -2.50]; Z=2.19, P =0.03 and SMD =-1.24,95% CI[-1.77, -0.71]; Z=4.56, P<0.00001) on postoperative day 1 (POD1) and postoperative day 3 (POD3) for NOSES than for CL. Pooled analysis revealed significantly lower interleukin-6 (IL-6) levels in the NOSES group (SMD=-1.88,95% CI [-2.84, -0.93]; Z=3.88, P=0.0001) on POD3. There were no significant differences in white blood cell (WBC) count, procalcitonin (PCT) levels or the incidence of infectious complications between the two groups. NOSES has a superior inflammatory profile and does not increase the incidence of postoperative infectious diseases. The reported results should be validated in a larger population of CRC patients.
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