{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:22:54Z","timestamp":1760059374237,"version":"build-2065373602"},"reference-count":47,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,6,10]],"date-time":"2025-06-10T00:00:00Z","timestamp":1749513600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Hand-assisted laparoscopic surgery (HALS) is a possible approach for rectal anterior resection (RAR). However, evidence supporting this technique remains limited. This study aims to evaluate the perioperative and oncological outcomes of HALS for RAR at a single tertiary oncology center. Methods: A retrospective observational study was conducted using a prospectively maintained database. Patients with primary adenocarcinoma of the rectosigmoid junction and rectum who underwent HALS for RAR between 1 January 2013 and 31 December 2022 were included. All surgeries were performed by a dedicated colorectal team composed of three surgeons. Results: Among the 1911 surgeries for primary colorectal cancer performed, 469 met the inclusion criteria. The median age was 66 (57\u201374) years and 63% of the patients were male. Most tumors were cT3-4 (78.9%) and cN+ (71.2%), and neoadjuvant therapy was administered in 70.0% of cases. Low RAR was performed in 73.1% of cases, and an anastomosis was constructed in 95% of cases. The median operative time was 152 (135\u2013180) min, and the conversion rate was 3.8%. Major morbidity occurred in 10.0% of cases, with 30-day and 90-day mortality rates of 0.9% and 1.3%, respectively. The overall anastomotic leak rate was 12.1%, with 9.0% early leaks and 3.1% late leaks. A complete\/near-complete mesorectal excision was achieved in 89.6% of cases and an R0 resection in 96.2% of cases. With a median follow-up of 87 months, the locoregional recurrence rate was 2.5%, whereas the distant recurrence rate was 5.9%. The 5-year overall survival was 82.6%. Conclusions: When performed by experienced teams, HALS for RAR is safe and feasible and is associated with a short operative time, low conversion rate, minimal morbidity, and optimal oncologic performance.<\/jats:p>","DOI":"10.3390\/jcm14124097","type":"journal-article","created":{"date-parts":[[2025,6,10]],"date-time":"2025-06-10T06:48:56Z","timestamp":1749538136000},"page":"4097","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Hand-Assisted Laparoscopic Rectal Resection\u2014Experience of a Tertiary Oncology Center"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6836-6154","authenticated-orcid":false,"given":"Beatriz","family":"Gon\u00e7alves","sequence":"first","affiliation":[{"name":"Department of General Surgery, Instituto Portugu\u00eas de Oncologia de Lisboa Francisco Gentil (IPOLFG), R. Prof. Lima Basto, 1099-023 Lisboa, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5934-6792","authenticated-orcid":false,"given":"Beatriz","family":"Costeira","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Instituto Portugu\u00eas de Oncologia de Lisboa Francisco Gentil (IPOLFG), R. Prof. Lima Basto, 1099-023 Lisboa, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9003-3871","authenticated-orcid":false,"given":"Filipa","family":"Fonseca","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Instituto Portugu\u00eas de Oncologia de Lisboa Francisco Gentil (IPOLFG), R. Prof. Lima Basto, 1099-023 Lisboa, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2992-7822","authenticated-orcid":false,"given":"Francisco","family":"Cabral","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Instituto Portugu\u00eas de Oncologia de Lisboa Francisco Gentil (IPOLFG), R. Prof. Lima Basto, 1099-023 Lisboa, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0356-8326","authenticated-orcid":false,"given":"Andr\u00e9","family":"Caiado","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Instituto Portugu\u00eas de Oncologia de Lisboa Francisco Gentil (IPOLFG), R. Prof. Lima Basto, 1099-023 Lisboa, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6912-4978","authenticated-orcid":false,"given":"Daniela","family":"Cavadas","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Instituto Portugu\u00eas de Oncologia de Lisboa Francisco Gentil (IPOLFG), R. Prof. Lima Basto, 1099-023 Lisboa, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2496-1642","authenticated-orcid":false,"given":"Jo\u00e3o","family":"Maciel","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Instituto Portugu\u00eas de Oncologia de Lisboa Francisco Gentil (IPOLFG), R. Prof. Lima Basto, 1099-023 Lisboa, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4645-1574","authenticated-orcid":false,"given":"Manuel","family":"Limbert","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Instituto Portugu\u00eas de Oncologia de Lisboa Francisco Gentil (IPOLFG), R. Prof. Lima Basto, 1099-023 Lisboa, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1097\/01.sla.0000141194.27992.32","article-title":"Operative Versus Nonoperative Treatment for Stage 0 Distal Rectal Cancer Following Chemoradiation Therapy: Long-term Results","volume":"240","author":"Perez","year":"2004","journal-title":"Ann. 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