Diseases of the Colon & Rectum最新文献

{"title":"Transanal Irrigation in Functional Constipation Long-term Results From an Italian National Study.","authors":"Ezio Falletto, Jacopo Martellucci, Piera Rossitti, Elena Zucchi, Andrea Bondurri, Gloria Zaffaroni, Simona Ascanelli, Laura Chimisso, Lucia d'Alba, Massimo Bellini, Christian Lambiase, Valter Ripetti, Paolo Luffarelli, Ilaria Clementi, Giovanni Cestaro, Corrado Bottini, Francesca Di Candido, Davide Zattoni, Silvia Cornaglia, Paolo Tonello, Andrea Lauretta, Mariagrazia Mirafiori","doi":"10.1097/DCR.0000000000004224","DOIUrl":"10.1097/DCR.0000000000004224","url":null,"abstract":"<p><strong>Background: </strong>Functional constipation is a chronic gastrointestinal disorder that significantly impairs quality of life.</p><p><strong>Objective: </strong>To evaluate the beneficial effects of transanal irrigation after 12 and 24 months of treatment in patients with functional constipation.</p><p><strong>Design: </strong>Multicenter, prospective, observational study.</p><p><strong>Settings: </strong>Thirteen gastroenterology centers across Italy.</p><p><strong>Patients: </strong>A total of 216 adults diagnosed with functional constipation were enrolled.</p><p><strong>Intervention: </strong>A transanal irrigation system was used to perform bowel irrigation. Patients completed validated questionnaires at baseline and at 1, 6, 12, and 24 months.</p><p><strong>Main outcome measures: </strong>The primary endpoints were to assess improvement in patient satisfaction and quality of life related to bowel function, as well as the safety of the procedure. Secondary outcomes included constipation severity, symptom occurrence, treatment discontinuation rates, and reasons for dropout.</p><p><strong>Results: </strong>Satisfaction score increased from 2.9 ± 2.4 at baseline to 6.5 ± 2.0 at 1 month and remained higher through 24 months ( p < 0.001). The quality of life total score improved from 2.7 ± 0.6 to 2.0 ± 0.7 at 1 month and about 1.9 thereafter ( p < 0.001). Constipation score severity decreased (Wexner score 17.9 ± 5.8 to 12.5 ± 5.2 at 1 month; maintained to 24 months; p < 0.001), and mean constipation-related symptoms declined from 3.3 to 1.0 per patient at 24 months. Of 175 patients prescribed irrigation, discontinuation occurred in 10.3% at 6 months, 9.1% at 12, and 6.3% at 24; technical difficulties were uncommon and absent at 24 months, and no serious adverse events were reported.</p><p><strong>Limitations: </strong>The non-randomized design may have introduced bias. Outcomes were assessed through validated but subjective self-reported questionnaires, and the study population was unbalanced for sex and comorbidities, although these factors did not significantly affect primary results.</p><p><strong>Conclusions: </strong>This study provides the first evidence to support the effectiveness and safety of long-term transanal irrigation in improving bowel function, symptoms and quality of life in patients with functional constipation over the long term. See Video Abstract .</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147728616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exosomal miRNA Predicts Response to Preoperative Chemoradiotherapy in Locally Advanced Rectal Cancer.","authors":"Yuma Wada, Masaaki Nishi, Takayuki Noma, Takuya Tokunaga, Hideya Kashihara, Chie Takasu, Toshiaki Yoshimoto, Mitsuo Shimada","doi":"10.1097/DCR.0000000000004253","DOIUrl":"10.1097/DCR.0000000000004253","url":null,"abstract":"<p><strong>Background: </strong>We recently reported blood-based transcriptomic biomarkers for the identification of response to preoperative chemoradiotherapy followed by surgery in patients with locally advanced rectal cancer.</p><p><strong>Objective: </strong>We sought to develop a liquid biopsy assay of exosomal miRNAs for identifying the response to preoperative chemoradiotherapy.</p><p><strong>Design: </strong>This was a retrospective study.</p><p><strong>Settings: </strong>This was a worldwide multicenter study with 2 international hospitals.</p><p><strong>Patients: </strong>We analyzed serum specimens from 81 patients in two independent international multicenter clinical cohorts (training n = 54; validation n = 27).</p><p><strong>Main outcome measures: </strong>Diagnostic performance and risk estimation for predicting pathological complete response.</p><p><strong>Results: </strong>A 5-miRNA panel was developed and integrated with CEA level into a final risk-assessment model. We identified patients with response to preoperative chemoradiotherapy (AUC = 0.86, 95% CI = 0.74-0.94). We validated the panel's performance in an independent validation cohort (AUC = 0.87, 95% CI = 0.68-0.97). The risk model was more accurate for the identification of response to PCRT than the panel (AUC = 0.90, 95% CI = 0.82-0.96, sensitivity = 0.82, specificity = 0.90). The risk model was applied to detect patients with pathologic complete response and it was superior to currently used pathological features (AUC = 0.92, 95% CI = 0.84-0.97, sensitivity = 0.78, specificity = 1.00). A comparative test for correlated ROC curves showed no significance ( p = 0.17). In multivariable analysis in the training and validation cohort, the miRNA panel was strongly associated with response (training: adjusted OR = 3.69, 95% CI = 3.16-59.32, p < 0.01; validation: adjusted OR = 32.93; 95% CI = 3.94-275.53; p < 0.01), respectively.</p><p><strong>Limitations: </strong>Retrospective clinical data.</p><p><strong>Conclusions: </strong>Our signature panel for predicting response to preoperative chemoradiotherapy has the potential for clinical translation as a liquid biopsy assay. (See Video Abstract ).</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147728584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary Linear Closure With Negative Pressure Wound Therapy Versus Pursestring Approximation After Ileostomy Reversal: A Randomized Noninferiority Trial.","authors":"Devesh S Ballal, Daniel J Borsuk, Mark Gabriel C Gonzalez, Marhama Zafar, Slawomir J Marecik, John J Park, Gerald Gantt, Kunal Kochar","doi":"10.1097/DCR.0000000000004212","DOIUrl":"https://doi.org/10.1097/DCR.0000000000004212","url":null,"abstract":"<p><strong>Background: </strong>The optimal method of wound closure after ileostomy reversal remains uncertain. Pursestring approximation reduces surgical site infections but requires prolonged wound care. Combining negative pressure wound therapy with primary linear closure may offer a more convenient approach while maintaining acceptable infection rates.</p><p><strong>Objective: </strong>To determine whether primary linear closure with negative pressure wound therapy is noninferior to pursestring approximation in preventing surgical site infection after ileostomy reversal.</p><p><strong>Design: </strong>Prospective, non-blinded, multi-institutional, non-inferiority randomized controlled trial.</p><p><strong>Settings: </strong>Community tertiary hospital and academic medical center.</p><p><strong>Patients: </strong>Adults undergoing elective ileostomy reversal between October 2018 and March 2024.</p><p><strong>Intervention: </strong>Participants were randomized to undergo either primary linear closure with negative pressure wound therapy or pursestring approximation for skin closure after ileostomy reversal.</p><p><strong>Main outcome measures: </strong>The primary outcome was the occurrence of surgical site infection, with a non-inferiority margin set at 16%. Secondary outcomes included time to wound healing and scar appearance using the validated Patient and Observer Scar Assessment Scale.</p><p><strong>Results: </strong>One hundred twelve patients completed the study, with 61 in the negative pressure wound therapy arm and 51 in the pursestring approximation arm. Primary linear closure- negative pressure wound therapy was noninferior to pursestring approximation arm in terms of SSI: 7% and 2% respectively with an absolute risk difference of 5% (95% CI: 2.5% to 12.5%). Early wound healing at 2 weeks was achieved in 77% vs 23.5% of patients, respectively (p < 0.001, GEE analysis). All wounds healed by 6 weeks in both groups. No negative pressure wound therapy device malfunctions occurred.</p><p><strong>Limitations: </strong>Nonblinded study limited to 2 institutions.</p><p><strong>Conclusions: </strong>Ileostomy reversal by Primary linear closure- negative pressure wound therapy is noninferior to pursestring approximation in terms of the occurrence of surgical site infections while achieving significantly faster wound healing. The method is safe, convenient and cosmetically acceptable. (See Video Abstract)Trial Registration: Advocate Aurora Health IRB, IRB# 22.034 (7082).</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147698118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single Institution Experience Using Circulating Tumor DNA to Monitor Recurrence in Rectal Cancer.","authors":"John C Hulse, Kristen M Quinn, Nathaniel Oberholtzer, Chloe Mattila, Elizabeth Hill, Virgilio V George, Colleen A Donahue","doi":"10.1097/DCR.0000000000004242","DOIUrl":"https://doi.org/10.1097/DCR.0000000000004242","url":null,"abstract":"<p><strong>Background: </strong>Standard of care for locally advanced rectal cancers includes total neoadjuvant therapy followed by surgery or non-operative management based on response. There remains significant risk of both local and distant recurrence, despite close surveillance. The use of circulating tumor DNA in rectal cancer surveillance has not yet been standardized.</p><p><strong>Objective: </strong>To assess the utility of circulating tumor DNA as an adjunct to surveillance for recurrence following definitive therapy.</p><p><strong>Design: </strong>Single institution retrospective review.</p><p><strong>Settings: </strong>Single National Cancer Institute designated and National Accreditation Program for Rectal Cancer accredited institution.</p><p><strong>Patients: </strong>All patients diagnosed with rectal cancer from 2021-2024 with circulating tumor DNA data available.</p><p><strong>Main outcome measures: </strong>Circulating tumor DNA status at the time of clinical recurrence. Subgroup analysis of recurrence location.</p><p><strong>Results: </strong>A total of 241 patients were diagnosed with rectal cancer between 2021-2024. Circulating tumor DNA data was available for 144/241 (59.8%). 28 patients with clinical recurrences were studied, 20 (71.4%) occurred after surgery and 8 (28.6%) during watch and wait. 20/28 (71.4%) recurrences had a positive circulating tumor DNA prior to detection of recurrence clinically. Circulating tumor DNA was positive a median of 100 days (range, 10-532 days) prior to recurrence being detected. 11/12 (91.7%) distant recurrences were circulating tumor DNA positive, compared to 10/17 (58.8%) local recurrences.</p><p><strong>Limitations: </strong>Retrospective single institution study with limited sample size.</p><p><strong>Conclusions: </strong>Circulating tumor DNA can be an asset during surveillance in both patients undergoing watch and wait or surgery, with identification of recurrences earlier than traditional methods. Within our study, a positive circulating tumor DNA was suggestive of distant metastases rather than local recurrence, which may impact decision making in the way we manage these patients, particularly when considering salvage surgery. Large prospective studies are needed to determine the ideal implementation of circulating tumor DNA into surveillance protocols. (See Video Abstract).</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147671416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Research Perspective on \"Barriers to Surgical Colorectal Cancer Care in the Rural United States: A Scoping Review\".","authors":"John Konen","doi":"10.1097/DCR.0000000000004256","DOIUrl":"https://doi.org/10.1097/DCR.0000000000004256","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147644312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers to Surgical Colorectal Cancer Care in the Rural United States: A Scoping Review.","authors":"Jeevan J Murthy, Ever Hernandez, Emily Groves, Kevin Train, Steph Hendren, J Andres Hernandez, Pasithorn A Suwanabol, Cody L Mullens","doi":"10.1097/DCR.0000000000004217","DOIUrl":"https://doi.org/10.1097/DCR.0000000000004217","url":null,"abstract":"<p><strong>Background: </strong>Colorectal cancer is a leading cause of oncologic morbidity and mortality in the United States, with rural populations facing greater barriers when accessing high-quality surgical care compared to their urban counterparts.</p><p><strong>Objective: </strong>We aim to highlight the extent and nature of such inequities, better informing policy and guiding future research.</p><p><strong>Data sources: </strong>Our search was made through CINAHL Complete (EBSCOhost), Embase (Elsevier), MEDLINE (PubMed), and Scopus (Elsevier) using keywords specific to colorectal cancer, surgical access, and rural populations in the US.</p><p><strong>Study selection: </strong>Papers included were original and focused on access to surgical services for rural colorectal cancer populations specific to the United States.</p><p><strong>Intervention: </strong>Two reviewers independently conducted title and abstract screening, full-text review, and data extraction. All final manuscripts were reviewed by the full authorship team before extraction.</p><p><strong>Main outcome measures: </strong>We aimed to outline the domains contributing to disparities in surgical access among rural colorectal cancer populations.</p><p><strong>Results: </strong>Our search yielded 5,218 unique citations, with 245 full-text articles assessed for inclusion. A total of 20 studies were included in the final synthesis. The review revealed that disparities in access to colorectal surgical care are influenced by critical overarching domains including geographic barriers, the healthcare workforce, underlying patient socioeconomics, and regional demographics.</p><p><strong>Limitations: </strong>Rural populations are highly heterogenous and each specific domain identified may have differing levels of impact in a specific community.</p><p><strong>Conclusion: </strong>Rural colorectal cancer populations face significant barriers to accessing surgical care compared to their urban counterparts across key domains. Policymakers should focus on measures to support rural healthcare systems and address workforce shortages to improve access and outcomes for underserved populations.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147644283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ulcerative Colitis-Associated Neoplasia.","authors":"Gilad Alon, Stefan Holubar","doi":"10.1097/DCR.0000000000004232","DOIUrl":"https://doi.org/10.1097/DCR.0000000000004232","url":null,"abstract":"<p><p>A 58-year-old man with a 20-year history of ulcerative colitis (UC) presented with partial large bowel obstruction, and colonoscopy demonstrated a partial obstructing splenic flexure mass, with the remaining colorectum showing quiescent colitis. His colitis was well controlled with ustekinumab, and his last colonoscopy was normal 2-years prior. Staging revealed no metastatic disease, and his carcinoembryonic antigen (CEA) was 2.0 ng/mL. A laparoscopic total abdominal colectomy with end ileostomy was performed. Pathology revealed pT3N0 colonic adenocarcinoma with several high-risk features (obstruction and microscopic lymphovascular invasion), and adjuvant chemotherapy was recommended. The patient was eager to undergo ileal pouch-anal anastomosis (IPAA). An examination under anesthesia (EUA) with multiple biopsies of the future rectal cuff was scheduled 1 month after completing chemotherapy.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147644365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complications After Rectal Cancer Surgery: Do Female Patients Fare Better? A Retrospective, Matched Cohort Analysis.","authors":"Alexander I Damanakis, Georg Dieplinger, Angela Ernst, Patricia K Wyzlic, Alexander Quaas, Lars M Schiffmann, Felix C Popp, Hans F Fuchs, Thomas Schmidt, Christiane J Bruns","doi":"10.1097/DCR.0000000000004211","DOIUrl":"10.1097/DCR.0000000000004211","url":null,"abstract":"<p><strong>Background: </strong>Rectum cancer is one of the most common cancers in the western world. The path towards personalized treatments in medicine includes further determination of sex-associated differences.</p><p><strong>Objective: </strong>The study's objective is to explore sex-related differences in the outcome of rectal surgery.</p><p><strong>Settings: </strong>All patients in the German StuDoQ|Rectum Registry who underwent rectal surgery for rectal cancer between 2013 and 2023 were included.</p><p><strong>Design: </strong>Propensity score matching was performed to account for comorbidities and factors influencing the surgery-associated outcome. Mediation analysis was performed to show the direct effect of sex on surgical and general complications.</p><p><strong>Main outcome measures: </strong>The main outcomes are morbidity and mortality.</p><p><strong>Patients: </strong>The total cohort included 19 664 patients (36.9% women) and 15 011 patients were included in this retrospective study. After propensity score matching, 10 362 patients were analyzed.</p><p><strong>Results: </strong>Women had fewer surgical complications (e.g., anastomotic leakage, 6.4% vs. 12.0%, p < 0.001), ileus (2.3% vs. 5.7%, p < 0.001)) and fewer general complications (e.g. pneumonia (1.5% vs. 3.6%, p < 0.001). In the propensity score matched cohort (n = 10,362), females had significantly lower odds of experiencing any complication (Clavien-Dindo I-V vs. 0) in matched conditional logistic regression analysis (adjusted odds ratio = 0.614; 95% CI: 0.566-0.666). Despite the strong influence of AL on morbidity, the positive effect of female sex was an independent factor for most complications in this cohort in Mediation Analysis.</p><p><strong>Limitations: </strong>Our study is limited by its retrospective design and the lack of some information like preoperative nicotine and alcohol consumption or the heterogenous definition of e.g. pelvic abscesses.</p><p><strong>Conclusion: </strong>In this retrospective multicenter registry study, female sex was associated with favorable outcomes after surgery for rectal cancer. See Video Abstract .</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147607902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic-Assisted Natural-Orifice Intracorporeal Anastomosis and Transrectal Extraction Procedure for Cancer: A Modified Approach With a Side-to-End Anastomosis and Stapled Colotomy Closure.","authors":"Michael H Froehlich, Mark A Heimberger, Deborah A Nagle, Nicholas J Ahn","doi":"10.1097/DCR.0000000000003840","DOIUrl":"10.1097/DCR.0000000000003840","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"670-671"},"PeriodicalIF":3.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145631334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Late Anastomotic Leakage After Rectal Cancer Surgery: Incidence and Differential Risk Factors.","authors":"Hyeon Kyeong Kim, In Ja Park, Jae Cheol Kang, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, Seok-Byung Lim","doi":"10.1097/DCR.0000000000004100","DOIUrl":"10.1097/DCR.0000000000004100","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Anastomotic leakage is a major complication of rectal cancer surgery, contributing to increased morbidity, poorer oncologic outcomes, and permanent stoma formation. However, consensus on its diagnostic time frame and risk factors is lacking. Anastomotic leakage in the late postoperative period is usually underrecognized owing to inconsistent definitions and variable surveillance protocols.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To investigate the serial incidence and risk factors for overall and late anastomotic leakage after curative-intent rectal cancer surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Retrospective cohort study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Settings: &lt;/strong&gt;Asan Medical Center, a tertiary referral center in Seoul, Korea.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients: &lt;/strong&gt;This study included 4472 patients who underwent rectal cancer resection with anastomosis between 2012 and 2020. Patients undergoing palliative or combined surgeries were excluded.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcome measures: &lt;/strong&gt;We analyzed the incidence and timing of anastomotic leakage and identified independent risk factors for overall and late anastomotic leakage using logistic regression.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The overall anastomotic leakage incidence was 3.2% (n = 145), with late anastomotic leakage comprising 48.3% (n = 70) of cases. Notably, 24.1% (n = 35) were diagnosed more than 1 year postoperatively. Of those with late anastomotic leakage, 78.6% (n = 56) had undergone diverting stoma formation. Independent risk factors for overall anastomotic leakage included younger age, male sex, low tumor location, and high inferior mesenteric artery ligation. Late anastomotic leakage was independently associated with neoadjuvant chemoradiotherapy (OR 3.573), robotic surgery (OR 4.734), and adjuvant chemotherapy (OR 3.420).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;The retrospective design and single-institution surveillance protocol may limit generalizability.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Late anastomotic leakage occurs at a rate comparable to early anastomotic leakage and presents with distinct risk factors. Extended surveillance and tailored management are warranted in high-risk patients. See Video Abstract.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Fuga anastomtica tarda tras ciruga de cncer rectal incidencia y factores de riesgo diferenciales: &lt;/strong&gt;ANTECEDENTES:La fuga anastomótica es una complicación importante de la cirugía del cáncer rectal, que contribuye al aumento de la morbilidad, a peores resultados oncológicos y a la formación de un estoma permanente. Sin embargo, no existe consenso sobre el plazo para su diagnóstico y los factores de riesgo. La fuga anastomótica en el periodo posoperatorio tardío suele pasar desapercibida debido a la inconsistencia de las definiciones y a la variabilidad de los protocolos de vigilancia.OBJETIVO:Investigar la incidencia seriada y los factores de riesgo de la fuga anastomótica general y tardía tras la cirugía de cáncer rectal con intención curat","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"565-576"},"PeriodicalIF":3.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146009257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}