{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T04:07:24Z","timestamp":1765512444446,"version":"3.48.0"},"reference-count":22,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T00:00:00Z","timestamp":1760313600000},"content-version":"vor","delay-in-days":12,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004484","name":"Tehran University of Medical Sciences and Health Services","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004484","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Science Reports"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Anastomotic leakage remains a serious concern in rectal cancer patients undergoing neoadjuvant chemoradiotherapy (nCRT) followed by low anterior resection (LAR). To mitigate this risk, protective\u200c ileostomy (PI) is often employed; \u200c\u200chowever, it carries its own complications and patient burden. This study aimed to evaluate the feasibility and clinical outcomes of ghost ileostomy (GI) as a potential alternative, aiming to reduce unnecessary stoma creation, related morbidity, readmission rates, and patient discomfort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this randomized, non\u2010inferiority feasibility trial, patients with rectal cancer who had received nCRT and were scheduled for LAR were enrolled. Feasibility outcomes included recruitment rate, retention, intervention adherence, procedural fidelity, and safety. Safety outcomes compared GI and PI regarding anastomotic leakage and failure, bowel obstruction, acute tubular necrosis (ATN), and readmissions due to complications (primary endpoint).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Eighty patients were randomized from 87 eligible participants, with a recruitment rate of 5.71 patients per site\u2010month. GI was non\u2010inferior to PI regarding overall complications and readmissions (one\u2010tailed 90% CI; power &gt;\u200980%) and also for obstruction and ATN (one\u2010tailed 95% CI; power &gt;\u200980%). However, the PI group had a significantly shorter initial hospital stay than the GI group (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.042).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This trial supports the feasibility of a definitive future study. GI may serve as a safe and effective alternative to PI in selected low\u2010risk rectal cancer patients undergoing nCRT and LAR. Larger, multicenter trials are needed to validate these findings and further explore the clinical utility of GI.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hsr2.71351","type":"journal-article","created":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T01:27:49Z","timestamp":1760405269000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Ghost Ileostomy Versus Protective Ileostomy in Rectal Cancer Followed by Low Anterior Resection: A Randomized Feasibility Trial"],"prefix":"10.1002","volume":"8","author":[{"given":"Seyed Mostafa","family":"Meshkati Yazd","sequence":"first","affiliation":[{"name":"Division of Colorectal Surgery, Department of Surgery Tehran University of Medical Sciences Tehran Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammad Reza","family":"Keramati","sequence":"additional","affiliation":[{"name":"Division of Colorectal Surgery, Department of Surgery Tehran University of Medical Sciences Tehran Iran"},{"name":"Colorectal Research Center Tehran University of Medical Sciences Tehran Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marzieh","family":"Ghanbari Ghalerudkhani","sequence":"additional","affiliation":[{"name":"Division of Colorectal Surgery, Department of Surgery Tehran University of Medical Sciences Tehran Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5454-495X","authenticated-orcid":false,"given":"Reza","family":"Shahriarirad","sequence":"additional","affiliation":[{"name":"School of Medicine Shiraz University of Medical Sciences Shiraz Iran"},{"name":"Thoracic and Vascular Surgery Research Center Shiraz University of Medical Sciences Shiraz Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amir","family":"Parsa","sequence":"additional","affiliation":[{"name":"School of Medicine Shiraz University of Medical Sciences Shiraz Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amir","family":"Keshvari","sequence":"additional","affiliation":[{"name":"Division of Colorectal Surgery, Department of Surgery Tehran University of Medical Sciences Tehran Iran"},{"name":"Colorectal Research Center Tehran University of Medical Sciences Tehran Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,10,13]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21442"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djab131"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.7150\/ijbs.15438"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00384-021-03833-w"},{"issue":"3","key":"e_1_2_13_6_1","first-page":"541","article-title":"Protective Ileostomy in Low Anterior Resection for Rectal Cancer \u2010\u2010 Can It be Avoided?","volume":"22","author":"Sheikh M. S.","year":"2013","journal-title":"Mymensingh medical journal: MMJ"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.4321\/S1130-01082012000700003"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1072-7515(97)00018-5"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-014-3974-z"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00384-018-3199-z"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000133186.81222.08"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.4219"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11136-015-1050-3"},{"volume-title":"Corman\u2032s Colon and Rectal Surgery","year":"2013","author":"Corman M. 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