{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T08:19:18Z","timestamp":1787818758174,"version":"build-2784847793"},"reference-count":27,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Annals of Gastroent Surgery"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>Circumferential resection margin (CRM) status is a well\u2010established prognostic factor in rectal cancer surgery; however, its long\u2010term oncological relevance has not been prospectively validated in Japan, where upfront surgery has long been widely used. This study assessed the prognostic impact of CRM in patients with locally advanced rectal cancer treated with minimally invasive surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The PRODUCT trial was a multicenter, prospective, observational study conducted at 18 institutions in Japan. Patients aged \u2265\u200920\u2009years with clinical stage II or III rectal adenocarcinoma located within 12\u2009cm from the anal verge and scheduled for laparoscopic or robotic surgery were enrolled. CRM positivity was defined as a margin of \u2264\u20091\u2009mm. Long\u2010term outcomes were analyzed using the Kaplan\u2013Meier method and Cox proportional hazards regression models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 303 eligible patients, CRM positivity was observed in 26 (8.6%). The 3\u2010year recurrence\u2010free survival (RFS) rate was significantly lower in the CRM\u2010positive group than in the CRM\u2010negative group (61.5% vs. 82.3%; log\u2010rank\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003). CRM positivity was independently associated with worse RFS (hazard ratio, 2.35; 95% confidence interval, 1.17\u20134.71;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.016). In patients with pT3\u2013T4 tumors, recurrence rates were significantly higher in CRM\u2010positive cases than in CRM\u2010negative cases (47.6% vs. 21.2%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.013). CRM status was not significantly associated with overall survival or cumulative incidence of local recurrence (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.057 and\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.706, respectively).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>CRM positivity is an adverse prognostic factor in Japanese patients with locally advanced rectal cancer undergoing MIS, underscoring the clinical importance of standardized CRM assessment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>Clinical Trials Registry, Identification Number: UMIN00034365<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ags3.70268","type":"journal-article","created":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T07:54:47Z","timestamp":1787817287000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic Impact of Circumferential Resection Margin in Minimally Invasive Surgery for Locally Advanced Rectal Cancer: A Multicenter Prospective Study"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5535-3514","authenticated-orcid":false,"given":"Atsushi","family":"Hamabe","sequence":"first","affiliation":[{"name":"Department of Gastroenterological Surgery, Graduate School of Medicine The University of Osaka  Suita Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1101-2707","authenticated-orcid":false,"given":"Masaaki","family":"Ito","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery National Cancer Center Hospital East  Kashiwa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3774-4739","authenticated-orcid":false,"given":"Shigeo","family":"Toda","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery Toranomon Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3738-9393","authenticated-orcid":false,"given":"Yusuke","family":"Suwa","sequence":"additional","affiliation":[{"name":"Department of Surgery, Gastroenterological Center Yokohama City University Medical Center  Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8641-8197","authenticated-orcid":false,"given":"Suguru","family":"Hasegawa","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery, Faculty of Medicine Fukuoka University  Fukuoka 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