{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T01:00:57Z","timestamp":1778288457524,"version":"3.51.4"},"reference-count":0,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2023,8,3]],"date-time":"2023-08-03T00:00:00Z","timestamp":1691020800000},"content-version":"vor","delay-in-days":24,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,7,10]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Anastomotic leakage is a major complication following rectal cancer surgery. The primary aim of this study was to investigate the efficacy of a protocol based on a quadruple intraoperative anastomotic assessment (4-Check) during transanal total mesorectal excision (TaTME).<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Patients who underwent TaTME for rectal cancer with primary anastomosis were reviewed and divided into two groups: before (pre-4-Check: April 2015 - April 2019) and after the implementation of the 4-Check protocol (May 2019 - May 2022). This protocol consisted of a multimodal anastomotic integrity assessment, including indocyanine green-evaluation of colonic stump and intraluminal anastomosis perfusion, a reverse air leak test and anastomotic doughnuts assessment. The primary outcome was incidence of clinical and\/or radiological anastomotic leakage. The secondary outcome included intraoperative anastomosis defects and repairs and 30-day complication rate. Propensity score matching and multivariable analyses were performed.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Of 186 patients, 160 were selected: 86 patients in the pre-4-Check and 74 in the 4-Check group. After propensity score matching, there was no difference in postoperative anastomotic leakage (pre-4-Check versus 4-Check: 11.1 per cent versus 7.4 per cent; P = 0.50). However, in the 4-Check group, the intraoperative detection of defects and repairs was significantly increased (P = 0.03), and the number of complications was reduced (pre-4-Check versus 4-Check: 33.3 per cent versus 9.3 per cent, P = 0.004). Multivariable analyses confirmed that the use of the 4-Check protocol, the detection of anastomotic defects and increased albumin levels were associated with a reduced number of complications.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n The 4-Check protocol allowed the intraoperative detection and repair of anastomotic defects. Anastomotic leakage rates were not reduced; however, 30-day complication rates were lower after implementation of this protocol.<\/jats:p>\n <\/jats:sec>","DOI":"10.1093\/bjsopen\/zrad072","type":"journal-article","created":{"date-parts":[[2023,8,3]],"date-time":"2023-08-03T21:13:26Z","timestamp":1691097206000},"source":"Crossref","is-referenced-by-count":7,"title":["\u20184-Check\u2019 protocol for intraoperative anastomotic assessment during transanal total mesorectal excision: retrospective cohort study"],"prefix":"10.1093","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6160-5992","authenticated-orcid":false,"given":"Flavio","family":"Tirelli","sequence":"first","affiliation":[{"name":"General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Rome , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Lorenzon","sequence":"additional","affiliation":[{"name":"General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Rome , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alberto","family":"Biondi","sequence":"additional","affiliation":[{"name":"General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Rome , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ilaria","family":"Neri","sequence":"additional","affiliation":[{"name":"General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Rome , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gloria","family":"Santoro","sequence":"additional","affiliation":[{"name":"General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Rome , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberto","family":"Persiani","sequence":"additional","affiliation":[{"name":"General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Rome , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2023,8,3]]},"container-title":["BJS Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/bjsopen\/article-pdf\/7\/4\/zrad072\/51315057\/zrad072.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/bjsopen\/article-pdf\/7\/4\/zrad072\/51315057\/zrad072.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,31]],"date-time":"2023-08-31T10:57:41Z","timestamp":1693479461000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/bjsopen\/article\/doi\/10.1093\/bjsopen\/zrad072\/7236570"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,10]]},"references-count":0,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2023,7,10]]}},"URL":"https:\/\/doi.org\/10.1093\/bjsopen\/zrad072","relation":{},"ISSN":["2474-9842"],"issn-type":[{"value":"2474-9842","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,8]]},"published":{"date-parts":[[2023,7,10]]},"article-number":"zrad072"}}