{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T15:46:54Z","timestamp":1792597614090,"version":"4.5.0"},"reference-count":54,"publisher":"American Medical Association (AMA)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"abstract":"\n IMPORTANCE<\/jats:title>\n For patients with slow-transit constipation (STC), total colectomy with ileorectal anastomosis (TC-IRA) remains the standard surgical treatment but is frequently complicated by diarrhea, fecal incontinence, and bowel obstruction. Subtotal colectomy with cecorectal anastomosis (SC-CRA) has emerged as a promising alternative; however, recurrence of constipation remains a critical concern. High-quality evidence comparing these 2 procedures is lacking.<\/jats:p>\n <\/jats:sec>\n \n OBJECTIVE<\/jats:title>\n To compare the 1-year Wexner Constipation Score of patients with STC who underwent SC-CRA vs TC-IRA.<\/jats:p>\n <\/jats:sec>\n \n DESIGN, SETTING, AND PARTICIPANTS<\/jats:title>\n This multicenter, open-label, noninferiority randomized clinical trial was conducted at 12 tertiary hospitals across 8 provinces in China from April 2022 to April 2025, with 12-month follow-up (final follow-up April 2026). Eligible participants were adults aged 18 years or older with Rome IV\u2013defined functional constipation, fewer than 1 spontaneous bowel movement per week, and long-term laxative dependence, defined as the regular use of osmotic or stimulant laxatives, or prokinetic agents, at least 3 times weekly for 6 months or longer before enrollment. Of 272 adults assessed, 252 were randomized. These data were analyzed from March 2025 to March 2026.<\/jats:p>\n <\/jats:sec>\n \n INTERVENTIONS<\/jats:title>\n Participants were randomly assigned in a 1:1 ratio to undergo either SC-CRA or TC-IRA.<\/jats:p>\n <\/jats:sec>\n \n MAIN OUTCOMES AND MEASURES<\/jats:title>\n The primary outcome was the Wexner Constipation Score (WCS) at 12 months, with a prespecified noninferiority margin of 1.32 points. Secondary outcomes included fecal incontinence, morbidity, quality of life, and patient-reported satisfaction.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n \n A total of 252 participants (mean age, 49.5 years; 221 female [87.7%] and 31 male [12.3%]) were randomized to undergo SC-CRA (n\u2009=\u2009126) or TC-IRA (n\u2009=\u2009126). At 12 months, adjusted mean (SD) WCS was 7.01 (3.31) in the SC-CRA group and 6.84 (3.68) in the TC-IRA group (adjusted mean difference, 0.17; 95% CI, \u20130.93 to 1.27), which fell within the prespecified noninferiority margin of 1.32 (\n P<\/jats:italic>\n \u2009=\u2009.02 for noninferiority). Early postoperative incontinence at 3 months was less frequent in the SC-CRA group than in the TC-IRA group (8.7% vs 21.4%; risk difference, \u201312.7%; 95% CI, \u201321.4% to \u20134.0%;\n P<\/jats:italic>\n \u2009=\u2009.01). Perioperative morbidity did not differ significantly between groups (10.3% vs 12.7%; risk difference, \u20132.4%; 95% CI, \u201310.3% to 5.5%;\n P<\/jats:italic>\n \u2009=\u2009.41), and quality-of-life scores at 12 months were comparable. However, patient-reported satisfaction at 12 months favored the TC-IRA group (97.5% vs 95.8%;\n P<\/jats:italic>\n \u2009=\u2009.03).\n <\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS AND RELEVANCE<\/jats:title>\n In this randomized clinical trial among patients with refractory STC, SC-CRA was noninferior to TC-IRA with respect to the WCS at 12 months, but patient-reported satisfaction at 1 year was higher in the TC-IRA group. Longer-term follow-up is needed.<\/jats:p>\n <\/jats:sec>\n \n TRIAL REGISTRATION<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT05352074<\/jats:ext-link>\n .\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamasurg.2026.4932","type":"journal-article","created":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T15:00:25Z","timestamp":1792594825000},"source":"Crossref","is-referenced-by-count":0,"title":["Subtotal Colectomy vs Total Colectomy for Slow-Transit Constipation"],"prefix":"10.1001","author":[{"given":"Man","family":"Guo","sequence":"first","affiliation":[{"name":"Department of General Surgery, Colorectal Division, Army Medical Center (Daping Hospital), Army Medical University, Chongqing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fan","family":"Li","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Colorectal Division, Army Medical Center (Daping Hospital), Army Medical University, Chongqing, 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China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Congqing","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Jiang","sequence":"additional","affiliation":[{"name":"Research Institute of General Surgery, General Hospital of the Eastern Theater Command of the PLA, Nanjing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenjing","family":"Gong","sequence":"additional","affiliation":[{"name":"Department of Anorectal Surgery, Zhejiang Provincial People\u2019s Hospital, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weidong","family":"Tong","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Colorectal Division, Army Medical Center (Daping Hospital), Army Medical University, Chongqing, 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