{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T19:37:21Z","timestamp":1785008241027,"version":"3.55.0"},"reference-count":33,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T00:00:00Z","timestamp":1769126400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T00:00:00Z","timestamp":1769126400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Anastomotic leakage (AL) remains a severe complication after low anterior resection (LAR) for rectal cancer, despite advances in minimally invasive (MI) techniques. This study aimed to evaluate the impact of a surgery\u2010focused care bundle, implemented on an enhanced recovery after surgery (ERAS)\u2010based perioperative protocol, on preventing AL and improving postoperative outcomes in patients with MI\u2013LAR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this retrospective historically controlled cohort study, a total of 306 patients who underwent MI\u2013LAR between 2011 and 2024 were included. A late\u2010phase cohort (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a081) receiving the care bundle with an ERAS\u2013based protocol (from September 2019) was compared with a historical early\u2010phase cohort (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0225). The surgery\u2010focused care bundle included robot surgery, preoperative oral antibiotics, indocyanine green blood flow evaluation, diverting stoma, transanal drainage tubes, and anastomotic reinforcement. Our institutional ERAS protocol was developed in accordance with the ERAS Society guidelines. Propensity score matching (PSM) was used to adjust for baseline differences between cohorts.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The AL rate significantly decreased from 14.7% (33\/225) to 2.5% (2\/81) after bundle implementation (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.01). Post\u2010PSM, AL rates remained significantly lower in the late\u2010phase cohort (18.0% vs. 1.3% and\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001). Severe complications (Clavien\u2013Dindo grade\u00a0\u2265\u00a03) and surgical site infections (SSIs) were also significantly reduced, and no reoperations were required in the late\u2010phase cohort. Multivariate analysis identified lack of care bundle (odds ratio [OR]: 6.36, 95% confidence interval [CI]: 1.42\u201328.4, and\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.01) and male sex (OR: 3.05, 95% CI: 1.24\u20137.52, and\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.01) as significant risk factors for AL.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Implementation of a surgery\u2010focused care bundle, integrated within an ERAS\u2010based perioperative framework, significantly reduced AL, severe complications, and SSIs after MI\u2010LAR, suggesting potential long\u2010term benefits by improving short\u2010term postoperative outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/wjs.70242","type":"journal-article","created":{"date-parts":[[2026,1,24]],"date-time":"2026-01-24T04:48:26Z","timestamp":1769230106000},"page":"547-557","source":"Crossref","is-referenced-by-count":4,"title":["Impact of an ERAS\u2010Based Surgical Care Bundle Implementation for Preventing Anastomotic Leakage in Minimally Invasive Low Anterior Resection for Rectal Cancer: A Retrospective Cohort Study"],"prefix":"10.1002","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2500-8810","authenticated-orcid":false,"given":"Koji","family":"Tamura","sequence":"first","affiliation":[{"name":"Department of Surgery and Oncology, Graduate School of Medical Sciences Kyushu University  Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takaaki","family":"Fujimoto","sequence":"additional","affiliation":[{"name":"Department of Surgery and Oncology, Graduate School of Medical Sciences Kyushu University  Fukuoka 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Graduate School of Medical Sciences Kyushu University  Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6285-6883","authenticated-orcid":false,"given":"Naoki","family":"Ikenaga","sequence":"additional","affiliation":[{"name":"Department of Surgery and Oncology, Graduate School of Medical Sciences Kyushu University  Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5717-8569","authenticated-orcid":false,"given":"Kohei","family":"Nakata","sequence":"additional","affiliation":[{"name":"Department of Surgery and Oncology, Graduate School of Medical Sciences Kyushu University  Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenoki","family":"Ohuchida","sequence":"additional","affiliation":[{"name":"Department of Surgery and Oncology, Graduate School of Medical Sciences Kyushu University  Fukuoka 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