Background:To investigate the clinical effects of the treatment of mid-superior rectal cancer with the natural orifice specimen extraction surgery (NOSES) guided by the concept of enhanced recovery after surgery (ERAS). Method: The clinical data of 80 patients with rectal cancer who met the inclusion criteria in Shaoyang’s Central Hospital from January 2018 to December 2020 were retrospectively analyzed. Results: All 80 patients underwent NOSES surgery and were managed with the ERAS concept during the perioperative period.Intraoperative conditions of 80 patients: The average operative time was (158.2±18.5)min; The average intraoperative bleeding was (26.0±14.5)ml; The average number of lymph nodes detected was (14.4±4.1). Postoperative complications related to 80 patients occurred: Postoperatively, two patients developed anastomotic leakage; One patient developed abdominal infection; One patient developed pulmonary infection; One patient developed postoperative intestinal obstruction; Three patients developed urinary retention. Postoperative recovery in 80 patients: The mean pain NRS score was (2.8±0.7); The firstly postoperative bedtime was (1.5±0.6)days; The average postoperative time to exhaustion was (2.0±0.5)days; And the average postoperative feeding time was (2.0±0.5)days. Postoperative psychological status of 80 patients: The postoperative psychological status of all 80 patients was excellent without depression and other adverse emotions. Conclusion: NOSES radical surgery for rectal cancer under the guidance of the ERAS concept further optimized the effect of minimally invasive, cosmetic, functional, and individualized treatment of laparoscopic rectal cancer surgery, and the combination of NOSES radical surgery for rectal cancer with ERAS concept has more tremendous advantages and is worth promoting and carrying out with good application prospects.

Objective:To investigate the relationship between preoperative NLR values, CEA, and other clinical and pathological indicators and potential lymph node metastasis in patients with cN0 stage (diagnosed by preoperative imaging) colorectal cancer, and to construct a clinical prediction model. Methods:The medical records of 430 patients with stage cN0 colorectal cancer who underwent radical surgical resection from January 2022 to June 2024 at Shaoyang Hospital affiliated to Nanhua University were retrospectively analyzed, and they were classified into lymph node metastasis group and no-lymph node metastasis group according to postoperative pathological diagnosis, and the relationship between clinical and pathological indexes, such as NLR, CEA, etc., and lymph node metastasis status was compared. Multifactorial logistic regression analysis was used to screen the independent risk factors of lymph node metastasis in patients with stage cN0 colorectal cancer, and the probability model of lymph node metastasis by logistic regression was constructed. The Nomogram of preoperative related risk factors for lymph node metastasis was further drawn by R language. Results: Multifactorial logistic regression analysis yielded that preoperative NLR, CEA, CA-199, preoperative T stage, and vascular invasion were the independent influencing factors of lymph node metastasis in patients with cN0 stage colorectal cancer (P<0.05); the sensitivity of single detection of CEA and NLR was: 73.20% and 72.00%; the specificity of single detection of CEA and NLR was, 68.70%; the sensitivity and specificity of combined detection were: 82.20%, 76.90%. By comparison, the AUC of NLR and CEA single test was 0.755 and 0.818, and the AUC of CEA+CEA combined test was 0.857. The risk nomogram prediction model of preoperative related indexes was constructed, and its area under the curve was 0.870. Conclusion:1. high preoperative NLR and CEA levels are independent influences on potential lymph node metastasis in patients with stage cN0 colorectal cancer;2. the efficacy of combined NLR and CEA detection was significantly higher than that of single detection;3. the clinical prediction model of lymph node metastasis constructed by preoperative related indexes had moderate differentiation and good consistency.