{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T13:57:33Z","timestamp":1789567053980,"version":"build-2803163510"},"reference-count":27,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2023,11,2]],"date-time":"2023-11-02T00:00:00Z","timestamp":1698883200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Colorectal Disease"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>There are several anastomotic techniques available to facilitate restorative rectal cancer surgery after total mesorectal excision (TME), including double\u2010stapled anastomosis (DST) and handsewn coloanal anastomosis (CAA). However, to date no one technique is superior with regard to anastomotic leakage (AL) or functional outcomes. Transanal transection single\u2010stapled anastomosis (TTSS) aims to overcome some of the technical challenges and offer comparable clinical and functional outcomes to traditional anastomotic techniques. The aim of this study was to explore the role of TTSS in modern rectal cancer surgery and to provide comparative clinical and functional outcome data with DST and CAA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>A prospective cohort study was undertaken to assess the safety and clinical and patient\u2010reported outcomes associated with the TTSS procedure. All patients undergoing sphincter\u2010preserving surgery for rectal cancer with an anastomosis performed within 6\u2009cm of the anal verge between January 2016 and April 2021 were prospectively enrolled into this study. Clinical and patient\u2010reported outcome data, including low anterior resection syndrome (LARS) assessment, were collected. The primary endpoint was anastomotic leakage within 30\u2009days.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 275 patients participated in this study, with 70 (25%) patients undergoing a TTSS, 110 (40%) undergoing a DST and 95 (35%) undergoing a CAA. Patients undergoing a CAA had more distal tumours than those having a TTSS or DST, with a median tumour height of 5, 7 and 9\u2009cm (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), respectively. We observed a statistically significant reduction in AL in the TTSS group compared with the DST group, with rates of 8.6% versus 20.9% (<jats:italic>p<\/jats:italic>\u2009=\u20090.028). There was no difference in LARS scores between patients undergoing TTSS and DST (<jats:italic>p<\/jats:italic>\u2009=\u20090.228), while patients with a CAA had worse LARS scores than TTSS patients (<jats:italic>p<\/jats:italic>\u2009=\u20090.002).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>TTSS is a technically safe and feasible anastomotic technique in rectal cancer surgery as an alternative to DST and CAA. Its advantages over DST are a reduced AL rate and, over CAA, improved function. It should therefore be considered as an alternative technique to improve clinical and patient\u2010reported outcomes in restorative rectal cancer surgery.<\/jats:p><\/jats:sec>","DOI":"10.1111\/codi.16789","type":"journal-article","created":{"date-parts":[[2023,11,3]],"date-time":"2023-11-03T04:09:55Z","timestamp":1698984595000},"page":"2346-2353","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["<scp>IDEAL<\/scp> Stage 2a\/b prospective cohort study of transanal transection and single\u2010stapled anastomosis for rectal cancer"],"prefix":"10.1111","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8493-3312","authenticated-orcid":false,"given":"Deena","family":"Harji","sequence":"first","affiliation":[{"name":"Bordeaux Colorectal Institute, Clinique Tivoli  Bordeaux 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