{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T14:59:03Z","timestamp":1790348343369,"version":"4.1.0"},"reference-count":41,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"content-version":"unspecified","delay-in-days":24,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"the National Key R&D Program of China","award":["2022YFE0134700"],"award-info":[{"award-number":["2022YFE0134700"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,9,11]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Immune checkpoint inhibitors (ICIs) are increasingly used before colorectal cancer surgery, particularly for mismatch repair-deficient or microsatellite instability-high tumours. Their surgery-specific safety, especially the risk of anastomotic leakage (AL), remains uncertain. We aim to synthesise AL and other postoperative outcomes after preoperative or perioperative ICI therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>We will search PubMed\/MEDLINE, Embase, Web of Science, Scopus, CENTRAL, ClinicalTrials.gov, CNKI and the WHO International Clinical Trials Registry Platform from inception to July 2026 without language restrictions. We will include randomised and non-randomised comparative studies, cohort and case\u2013control studies and single-arm studies reporting postoperative outcomes after preoperative or perioperative ICI therapy; case reports and case series with fewer than five surgically treated patients will be excluded. The primary outcome is AL among patients who underwent bowel resection with a constructed intestinal anastomosis. Two reviewers will independently screen records, extract data and assess risk of bias using design-appropriate validated tools. Comparative and non-comparative studies will be analysed separately: risk ratios from comparative studies will be pooled in random-effects models, and single-arm AL rates will be pooled as proportions using a binomial-logit generalised linear mixed model. Heterogeneity, prespecified subgroup analyses, sensitivity analyses and the certainty of the evidence (Grading of Recommendations Assessment, Development and Evaluation) will be reported.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethics approval is not required because only published aggregate data will be used. Results will be submitted to a peer-reviewed journal and presented at scientific meetings. Extraction materials, analytical code and the derived dataset will be shared in an open repository with the completed review.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD420261426134.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-125867","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T14:05:37Z","timestamp":1790345137000},"page":"e125867","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Surgical safety of preoperative or perioperative immune checkpoint inhibitors in colorectal cancer surgery: protocol for a systematic review and meta-analysis focusing on anastomotic leakage"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-6015-2132","authenticated-orcid":false,"given":"Jing","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Gastrointestinal Surgery, The Third Xiangya Hospital, Central South University, Changsha, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuhong","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, The Third Xiangya Hospital, Central South University, Changsha, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baiwang","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, The Third Xiangya Hospital, Central South University, Changsha, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhengqi","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, The 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