{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:25:43Z","timestamp":1786976743606,"version":"build-2736575974"},"reference-count":36,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,1,7]],"date-time":"2025-01-07T00:00:00Z","timestamp":1736208000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Annals of Gastroent Surgery"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Although extensive research has been conducted on early anastomotic leakage (AL) after sphincter\u2010sparing surgery, the status of late anastomotic complications (post\u201030\u2009days) has received limited attention. These late complications significantly affect a patient's quality of life and often lead to permanent stoma creation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study conducted a sub\u2010analysis of a phase II trial assessing the outcomes of laparoscopic surgery for cStage I lower rectal adenocarcinoma (the ultimate trial). This study included 278 patients who underwent intestinal anastomosis and investigated the frequency, timing, and risk factors of late anastomotic complications (stenosis, fistula, and intestinal prolapse).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Anastomotic stenosis occurred in 27 patients (9.7%), and the median time of occurrence was 274\u2009days (range, 70\u20131226\u2009days). Only early AL (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.004) was identified as an independent risk factor. A late anastomotic fistula was observed in five patients (1.8%), and 18 patients (6.4%) requiring permanent stomas. A short distance from the lower tumor margin to the anal verge (AV) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.004) and the presence of stenosis or fistula (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001) were independent risk factors.\n                    <\/jats:p>\n                    <jats:p>\n                      Intestinal prolapse occurred in eight cases (3%), with a median occurrence of 221\u2009days (range, 122\u2013725\u2009days). Intersphincteric resection (ISR) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02) and splenic flexure takedown (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001) were independent risk factors.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Anastomotic stenosis and late fistula formation frequently emerge as secondary consequences of early AL and represent significant complications linked to permanent stoma creation, often proving resistant to treatment. Intestinal prolapse is a characteristic anastomotic complication of ISR that can be caused by excessive intestinal mobilization.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ags3.12904","type":"journal-article","created":{"date-parts":[[2025,1,7]],"date-time":"2025-01-07T09:00:23Z","timestamp":1736240423000},"page":"719-729","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Late anastomotic complication after laparoscopic surgery for clinical stage I low rectal cancers located within 5\u2009cm of the anal verge: Sub\u2010analysis of the ultimate trial"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8078-0091","authenticated-orcid":false,"given":"Manabu","family":"Shimomura","sequence":"first","affiliation":[{"name":"Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences Hiroshima University  Hiroshima 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Transplant Surgery, Graduate School of Biomedical and Health Sciences Hiroshima University  Hiroshima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Department of Surgery Gastroenterological Center, Yokohama City University Medical Center  Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yosuke","family":"Fukunaga","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery, Cancer Institute Hospital Japanese Foundation of Cancer Research  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasumitsu","family":"Hirano","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery Saitama Medical University International Medical Center  Hidaka 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