{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T05:27:22Z","timestamp":1786944442942,"version":"build-2736575974"},"reference-count":16,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"vor","delay-in-days":35,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100022878","name":"Colorectal Surgical Society of Australia and New Zealand","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100022878","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["1009973"],"award-info":[{"award-number":["1009973"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["APP1078113"],"award-info":[{"award-number":["APP1078113"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100021671","name":"National Cancer Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100021671","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["U10CA180821"],"award-info":[{"award-number":["U10CA180821"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["U10CA180882"],"award-info":[{"award-number":["U10CA180882"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["U10CA180790"],"award-info":[{"award-number":["U10CA180790"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["U10CA180833"],"award-info":[{"award-number":["U10CA180833"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["U10CA18036"],"award-info":[{"award-number":["U10CA18036"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["U10CA180858"],"award-info":[{"award-number":["U10CA180858"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The multicentre ALaCaRT and ACOSOG Z6051 randomized trials were unable to demonstrate non-inferiority of laparoscopic versus open surgery for rectal cancer with respect to a composite pathology metric indicating successful resection. Neither trial was individually powered to detect differences in long-term recurrence or survival. This planned meta-analysis determined long-term oncological outcomes of laparoscopic versus open proctectomy for rectal adenocarcinoma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prospective meta-analysis included individual patient data from patients with cT1\u20133\u2005N0\u20132\u2005M0 rectal adenocarcinoma enrolled in the ALaCaRT and ACOSOG Z6051 trials. Pathologically successful resection was defined as complete or near-complete total mesorectal excision, a clear circumferential resection margin (CRM; &amp;gt; 1\u2005mm), and a clear distal resection margin (&amp;gt; 1\u2005mm). The non-inferiority margin for disease-free survival (DFS) was an absolute difference of 5% at least 3 years after surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The combined data set included 935 patients (65.6% men, mean age 60.7 years, mean body mass index 26.7\u2005kg\/m2) randomized to open (457 patients) or laparoscopic (478 patients) proctectomy. Pathologically successful resection was lower in the laparoscopic than open group (85.1% versus 89.9%, respectively; pooled estimate 4.6% difference; 95% confidence interval (c.i.) \u22128.6% to \u22120.5%). The median follow-up was 60.2 (interquartile range 49.9\u201361.1) months. Three-year DFS was 75.2% (95% c.i. 71.1% to 79.2%) and 76.5% (95% c.i. 72.5% to 80.6%) for the laparoscopic and open groups, respectively (pooled estimate difference \u22121.5%; 95% c.i. \u22127.2% to 4.2%). Non-inferiority of laparoscopic surgery was not demonstrated because the lower one-sided 95% c.i. (\u22126.3% to 100%) crossed \u22125%. Three-year locoregional recurrence was higher in laparoscopic than open group (5.4% (95% c.i. 3.3% to 7.5%) versus 2.0% (95% c.i. 0.7% to 3.4%), respectively; pooled estimate 3.1% difference (95% c.i. 0.6% to 5.6%)). A clear CRM was the most significant and only pathological predictor of both DFS (P &amp;lt; 0.0001) and overall survival (P &amp;lt; 0.0001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Laparoscopic proctectomy led to a lower rate of pathologically successful resection and a higher rate of locoregional recurrence at 3 years. The possibility of subsequent poorer DFS or overall survival rate requires further evaluation, because this analysis was not specifically powered for these endpoints.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/bjsopen\/zrag119","type":"journal-article","created":{"date-parts":[[2026,7,5]],"date-time":"2026-07-05T11:34:14Z","timestamp":1783251254000},"source":"Crossref","is-referenced-by-count":0,"title":["Laparoscopic\n                    <i>versus<\/i>\n                    open surgery for rectal cancer: individual patient data meta-analysis of the ALaCaRT and Z6051 randomized trials"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0967-8515","authenticated-orcid":false,"given":"Kilian G M","family":"Brown","sequence":"first","affiliation":[{"name":"Department of Colorectal Surgery, Royal Prince Alfred Hospital , Sydney, New South Wales ,","place":["Australia"]},{"name":"Surgical Outcomes Research Centre (SOuRCe) and Institute of Academic Surgery, Royal Prince Alfred Hospital , Sydney, New South Wales ,","place":["Australia"]},{"name":"Faculty of Medicine and Health, Central Clinical School, University of Sydney , Sydney, New South Wales ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew R L","family":"Stevenson","sequence":"additional","affiliation":[{"name":"Royal Brisbane and Women\u2019s Hospital Department of Colorectal Surgery, , Brisbane, Queensland ,","place":["Australia"]},{"name":"Faculty of Health, Medicine and Behavioural Sciences, University of Queensland , Brisbane, Queensland ,","place":["Australia"]},{"name":"Faculty of Medicine and Health, National Health and Medical Research Council Clinical Trials Centre, University of Sydney , Camperdown, New South Wales ,","place":["Australia"]},{"name":"St Vincent\u2019s Private Hospital Northside , Brisbane, Queensland ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5602-6045","authenticated-orcid":false,"given":"Michael J","family":"Solomon","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Royal Prince Alfred Hospital , Sydney, New South Wales ,","place":["Australia"]},{"name":"Surgical Outcomes Research Centre (SOuRCe) and Institute of Academic Surgery, Royal Prince Alfred Hospital , Sydney, New South Wales ,","place":["Australia"]},{"name":"Faculty of Medicine and Health, Central Clinical School, University of Sydney , Sydney, New South Wales ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Murray","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health, National Health and Medical Research Council Clinical Trials Centre, University of Sydney , Camperdown, New South Wales ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate","family":"Wilson","sequence":"additional","affiliation":[{"name":"Surgical Outcomes Research Centre (SOuRCe) and Institute of Academic Surgery, Royal Prince Alfred Hospital , Sydney, New South Wales ,","place":["Australia"]},{"name":"Faculty of Medicine and Health, Central Clinical School, University of Sydney , Sydney, New South Wales ,","place":["Australia"]},{"name":"Faculty of Medicine and Health, National Health and Medical Research Council Clinical Trials Centre, University of Sydney , Camperdown, New South Wales ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8748-1844","authenticated-orcid":false,"given":"Val","family":"Gebski","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health, National Health and Medical Research Council Clinical Trials Centre, University of Sydney , Camperdown, New South Wales ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Fleshman","sequence":"additional","affiliation":[{"name":"Department of Surgery, Baylor University Medical Center , Dallas, Texas ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4640-8832","authenticated-orcid":false,"given":"Qian","family":"Shi","sequence":"additional","affiliation":[{"name":"Mayo Clinic Division of Clinical Trials and Biostatistics, , Rochester, Minnesota ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas E","family":"Read","sequence":"additional","affiliation":[{"name":"University of Hawaii John A. 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