{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T18:56:26Z","timestamp":1790794586869,"version":"4.1.0"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":26,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Anterior tumour location is an established risk factor for local recurrence (LR) in advanced rectal cancer, but its significance in stage I ultra-low rectal cancer remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This exploratory supplemental analysis used data from Ultimate trial, a multicentre prospective phase II study across 47 Japanese institutions (2014\u20132017). Patients with cT1\u20132 N0 M0 ultra-low rectal cancer (\u2264 5\u2005cm from the anal verge) underwent laparoscopic resection. Tumour location was categorized as anterior (10\u20132 o\u2019clock) or non-anterior (2\u201310 o\u2019clock). The primary endpoint was LR; secondary endpoints included recurrence-free survival, overall survival, and stoma-free survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 300 enrolled patients, 297 were analysed (median follow-up 37.2\u2005months); 93 tumours (31.3%) were anterior. Baseline characteristics, operative outcomes, and pathological findings were similar between the two groups. The 3-year cumulative LR rate was 11.9% for anterior tumours and 3.0% for non-anterior tumours (hazard ratio (HR) 4.46; 95% confidence interval (c.i.) 1.67 to 11.89; P = 0.001). Multivariable analysis showed an independent association between anterior location and LR (HR 4.68; 95% c.i. 1.72 to 12.74); subgroup analysis revealed no difference in clinical (c) T1 patients, but a significantly higher LR rate for anterior tumours in cT2 patients (25.3% versus 4.7%; P &amp;lt; 0.001). Three-year recurrence-free survival (83.9% for anterior tumours versus 88.9% for non-anterior tumours; P = 0.222), overall survival (&amp;gt; 95%), and stoma-free survival were comparable between the two groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Anterior tumour location in the ultra-low rectum was associated with an increased risk of LR, particularly in cT2 patients, highlighting the need for a more refined treatment strategy and vigilant monitoring.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/bjsopen\/zrag128","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T11:51:25Z","timestamp":1784116285000},"source":"Crossref","is-referenced-by-count":0,"title":["Anterior tumour location as a risk factor for local recurrence after laparoscopic surgery for stage I ultra-low rectal cancers: exploratory analysis of the Ultimate trial"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5807-668X","authenticated-orcid":false,"given":"Atsushi","family":"Kohyama","sequence":"first","affiliation":[{"name":"Department of Surgery, Tohoku University Graduate School of Medicine , Sendai ,","place":["Japan"]},{"name":"Department of Surgery, Iwaki City Medical Center , Iwaki ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0205-8957","authenticated-orcid":false,"given":"Shinobu","family":"Ohnuma","sequence":"additional","affiliation":[{"name":"Department of Surgery, Tohoku University Graduate School of Medicine , Sendai ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuichiro","family":"Tsukada","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, National Cancer Center Hospital East , Chiba 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