{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T16:20:49Z","timestamp":1788020449402,"version":"build-2784847793"},"reference-count":30,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,7,9]],"date-time":"2025-07-09T00:00:00Z","timestamp":1752019200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Annals of Gastroent Surgery"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Preserving anorectal function while achieving oncological success is crucial in the treatment of lower rectal cancer near the anal canal. Despite advancements in laparoscopic surgery that facilitate anal preservation, post\u2010operative anorectal dysfunction considerably affects quality of life. Both hand\u2010sewn and stapled anastomoses are suitable options for tumors located 4\u20135\u2009cm from the anus. However, evidence comparing the functional outcomes and complications associated with both anastomosis methods is lacking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This multicenter, single\u2010arm prospective study included patients with cT1\u2010T2\/N0\/M0 adenocarcinoma located 4\u20135\u2009cm from the anal verge, scheduled for upfront laparoscopic surgery. Anorectal function, post\u2010operative complications, urinary and male sexual function, and oncological outcomes were assessed using the validated scores.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 135 patients were analyzed and divided into hand\u2010sewn (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200965) and stapled (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200970) groups. The patient characteristics were similar, except for the tumors in the hand\u2010sewn group located 1\u2009mm closer to the anal verge. No significant differences were observed in the post\u2010operative complications. Anorectal function, measured using Wexner scores, worsened at 3\u2009months postoperatively and gradually improved in both groups. At 3, 6, 12, 24, and 36\u2009months, the stapled group consistently showed better Wexner scores than the hand\u2010sewn group. Urinary function, sexual function, and oncological outcomes were similar in both groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Stapled anastomosis may provide better anorectal function with comparable safety and oncological outcomes to hand\u2010sewn anastomosis. Therefore, stapled anastomosis may be preferred for tumors located 4\u20135\u2009cm from the anal verge to ensure oncological safety.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>This study was registered in the UMIN Clinical Trials Registry System (UMIN 000011750)<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ags3.70063","type":"journal-article","created":{"date-parts":[[2025,7,9]],"date-time":"2025-07-09T12:35:35Z","timestamp":1752064535000},"page":"1215-1224","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Patient\u2010Reported Outcomes and Surgical Results of Hand\u2010Sewn Versus Stapled Anastomosis for Lower Rectal Cancer Located 4\u20135\u2009cm From the Anal Verge: A Subanalysis of the Ultimate Study"],"prefix":"10.1002","volume":"9","author":[{"given":"Masakatsu","family":"Numata","sequence":"first","affiliation":[{"name":"Department of Surgery, Gastroenterological Center Yokohama City University Medical Center  Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Department of Surgery, Gastroenterological Center Yokohama City University Medical Center  Kanagawa Japan"},{"name":"Department of Colorectal Surgery Kansai Medical University  Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuichiro","family":"Tsukada","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery National Cancer Center Hospital East  Chiba Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuke","family":"Suwa","sequence":"additional","affiliation":[{"name":"Department of Surgery, Gastroenterological Center Yokohama City University Medical Center  Kanagawa 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":"Division of Gastroenterological Surgery Saitama Medical University International Medical Center  Saitama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7087-1667","authenticated-orcid":false,"given":"Kazuhiro","family":"Sakamoto","sequence":"additional","affiliation":[{"name":"Department of Coloproctological Surgery Juntendo University Faculty of Medicine  Tokyo 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