BJS Open最新文献

{"title":"Surgical Site Infections in Major Lower Limb Amputation (SIMBA): international multicentre study.","authors":"","doi":"10.1093/bjsopen/zrag042","DOIUrl":"10.1093/bjsopen/zrag042","url":null,"abstract":"<p><strong>Introduction: </strong>Surgical site infection (SSI) after major lower limb amputation (MLLA) significantly affects function, mobility, morbidity, and mortality, alongside broader impacts on healthcare services. Limited data exist on the incidence, prevention, and management of SSI after MLLA. Improving outcomes and wound healing have been identified as research priorities for patients following MLLA.</p><p><strong>Methods: </strong>Surgical Site Infection in Major Lower Limb Amputation (SIMBA) is an international, prospective, collaborative observational study. Data were collected for consecutive patients undergoing MLLA over 8 months, with 30-day follow-up. Outcomes included the incidence of SSI (defined using Centers for Disease Control and Prevention criteria), wound dehiscence (defined as any partial or complete separation of the incision or flap, with or without infection), further intervention, mortality, adjunct use, and SSI predictors.</p><p><strong>Results: </strong>Validated data for 1314 MLLAs from 46 centres in the UK (34), Europe (9), Australasia (2), and Asia (1) were collected, comprising 643 (48.9%) transfemoral, 41 (3.1%) through-knee, and 628 (47.8%) transtibial amputations. The most common indications were ischaemia (56.6%, 742) and uncontrolled infection (22.3%, 293). The incidences of SSI and wound breakdown were 10.9% (135 of 1238) and 16.7% (204 of 1217), respectively. Low glomerular filtration rate, cardiac disease, dirty/infected wound class, and transtibial amputations were independent predictors of SSI. SSI was associated with increased postoperative morbidity, wound breakdown, further intervention, and delays in fitness for discharge. The 30-day mortality rate was 7.0% (92 of 1314), with no significant association with SSI.</p><p><strong>Conclusion: </strong>SSI and wound breakdown are common following MLLA, and are associated with increased morbidity, delayed recovery, and revision surgery. These findings identify patient- and procedure-specific factors associated with elevated SSI risk, and a lack of procedure-specific evidence, revealing critical gaps in SSI prevention strategies. Addressing these are essential to improve patient outcomes, reduce healthcare costs, and guide future research.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13543170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Defining absolute postoperative desmoid risk in familial adenomatous polyposis according to APC genotype and family history: retrospective cohort study.","authors":"Benjamin Zare, Massih Bahar, Susan Clark, Andrew Latchford","doi":"10.1093/bjsopen/zrag090","DOIUrl":"10.1093/bjsopen/zrag090","url":null,"abstract":"<p><strong>Background: </strong>Desmoid disease is a major cause of morbidity and mortality in familial adenomatous polyposis (FAP), particularly after prophylactic colorectal surgery. Although APC genotype and family history are recognized risk factors, previous sizeable studies report relative rather than absolute risks. This study aimed to quantify absolute postoperative desmoid risk in FAP patients undergoing risk-reducing colectomy, stratified by APC genotype, and to assess the modifying effect of family history.</p><p><strong>Methods: </strong>This retrospective observational study used records from a prospectively maintained registry. Patients with an APC pathogenic variant (PV) 3' of codon 1399 were classified as high risk, and those with an APC PV 5' of (or at) codon 1399 were classified as low risk. Patients who had not undergone prophylactic colectomy, with < 5 years of postoperative follow-up, or those with a desmoid diagnosed before or at the time of surgery were excluded. Clinical records were reviewed for details of surgery, desmoid diagnosis, and family history. A positive family history was defined as a first-degree relative with genetically confirmed FAP and a diagnosis of desmoid disease (clinical and/or radiological).</p><p><strong>Results: </strong>Among 48 high-risk patients, 30 (63%) developed desmoid, with no significant difference between colectomy and proctocolectomy (54% versus 70%, respectively; χ2 = 1.42; P = 0.233). Family history was present in 35 of the 48 patients (73%) and increased desmoid risk relative to no family history (80% versus 15%, respectively; P < 0.01). Among the 1213 low-risk patients, 154 (12.7%) developed desmoids, with no significant effect of surgical procedure (13.9% versus 12.1% for proctocolectomy and total/partial colectomy, respectively; χ² = 0.77; P = 0.380). Family history increased desmoid risk relative to no family history (30% versus 10%, respectively; P < 0.01).</p><p><strong>Conclusion: </strong>A family history of desmoid disease appears to be an important determinant of postoperative desmoid risk in FAP. Although APC PV 3' of codon 1399 does confer a high overall risk, this is largely confined to individuals with first-degree relatives with desmoid. In the absence of a family history, postoperative desmoid risk appeared relatively low regardless of genotype. This supports a more individualized approach to perioperative counselling and surgical decision-making in patients with FAP. In addition, these data highlight that patients with both a 3' APC PV and a positive family history are a particularly high-risk subgroup who may represent an appropriate target population for future chemoprevention trials.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13591399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149011939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early inflammatory signal in late-diagnosed anastomotic leakage after anterior resection.","authors":"Martin Rutegård, Josefin Segelman, Peter Matthiessen, Marie-Louise Lydrup, Jennifer Park","doi":"10.1093/bjsopen/zrag127","DOIUrl":"10.1093/bjsopen/zrag127","url":null,"abstract":"","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623004/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic impact of low versus high inferior mesenteric artery ligation in rectosigmoid cancer: individual patient data meta-analysis of randomized trials.","authors":"Alberto Aiolfi, Francesco Cammarata, Emanuele Rausa, Gianluca Bonitta, Antonio Biondi, Luigi Bonavina, Davide Bona","doi":"10.1093/bjsopen/zrag120","DOIUrl":"10.1093/bjsopen/zrag120","url":null,"abstract":"<p><strong>Background: </strong>The optimal level of inferior mesenteric artery ligation in rectosigmoid cancer surgery remains a matter of debate. This study evaluated the prognostic impact of low ligation (LL) versus high ligation (HL) after rectal or sigmoid cancer resection.</p><p><strong>Methods: </strong>A reconstructed individual patient data meta-analysis of randomized clinical trials (RCTs) was performed using restricted mean survival time difference (RMSTD) estimation. PubMed, MEDLINE, Scopus, Web of Science, ClinicalTrials.gov, Cochrane Central Library, and Google Scholar were searched. Primary outcomes were 5-year overall (OS) and disease-free survival (DFS). The RMSTD, risk ratio (RR), standardized mean difference (SMD), and 95% confidence interval (c.i.) were used as pooled effect size measures. The certainty of evidence was categorized with the GRADE framework.</p><p><strong>Results: </strong>Overall, 1152 patients from five RCTs were included; 34% underwent LL. Baseline demographics and pathological tumour stage were balanced among the LL and HL groups. At the 60-month follow-up, the OS and DFS estimates for LL versus HL were 1.40 months (95% c.i. -0.18 to 2.98; moderate level of certainty) and 0.71 months (95% c.i. -1.55 to 3.03; moderate level of certainty). Anastomotic leak (RR 0.71), overall complications (RR 0.79), total number of lymph nodes retrieved (SMD 0.01), and operating time (SMD 0.08) were comparable.</p><p><strong>Conclusion: </strong>This meta-analysis did not detect a statistically significant difference in 5-year OS and DFS between LL and HL in patients with rectosigmoid cancer.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13563187/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tolerability of dose-escalating early postoperative intraperitoneal chemotherapy in colorectal cancer with peritoneal disease: EFFIPEC single-arm phase I study.","authors":"Elinor Bexe Lindskog, Lana Ghanipour, Gabriella Jansson Palmer, Dan Asplund, Caroline Nordenvall, Helgi Birgisson, Ingvar Syk, Torbjörn Swartling, Per J Nilsson, Jan-Erik Frödin, Victor Verwaal, Wilhelm Graf, Peter Cashin","doi":"10.1093/bjsopen/zrag121","DOIUrl":"https://doi.org/10.1093/bjsopen/zrag121","url":null,"abstract":"","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intrawound vancomycin for prevention of surgical site infection: meta-analysis of randomized clinical trials.","authors":"Shaan Patel, Shiva A Nischal, Kush M Kale, Angelette Mendonca, Nelson Sofoluke, Srinivas K Prasad, James S Harrop, Daniel Refai","doi":"10.1093/bjsopen/zrag131","DOIUrl":"10.1093/bjsopen/zrag131","url":null,"abstract":"<p><strong>Background: </strong>Surgical site infection remains a major cause of postoperative morbidity. Intrawound vancomycin has been proposed as an adjunct to standard prophylaxis, but its effectiveness across surgical settings remains uncertain. This systematic review and meta-analysis of randomized clinical trials aimed to evaluate the association between intraoperative intrawound vancomycin and surgical site infection in adults undergoing surgery.</p><p><strong>Methods: </strong>MEDLINE, Embase, and CENTRAL were searched from database inception to March 2026 for randomized clinical trials comparing intrawound vancomycin with standard care in adults undergoing operative procedures. Two reviewers independently performed screening, data extraction, and risk-of-bias assessment using the Cochrane Risk of Bias 2 tool. Random-effects meta-analyses were undertaken, with certainty of evidence rated using the Grading of Recommendations Assessment, Development and Evaluation framework. Primary outcomes were overall surgical site infection, deep surgical site infection, superficial surgical site infection, and Gram-positive surgical site infection.</p><p><strong>Results: </strong>Twenty-two trials enrolling 8424 patients (vancomycin 4228, control 4196) were included. Intrawound vancomycin was associated with a lower risk of overall surgical site infection (risk ratio 0.79, 95% confidence interval 0.64 to 0.99) and Gram-positive surgical site infection (risk ratio 0.53, 0.35 to 0.79), corresponding to numbers needed to treat of 82 and 78, respectively. No significant differences were observed for deep or superficial surgical site infection, Gram-negative infection, reoperation, wound complications, mortality, or length of hospital stay. The certainty of evidence was moderate.</p><p><strong>Conclusion: </strong>Intrawound vancomycin was associated with a modest reduction in surgical site infection, driven by reductions in Gram-positive infections. These findings support a selective, context-specific use rather than routine application across all procedures.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13591277/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149011890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preventing pancreatic fistula following pancreatectomy: meta-analysis of randomized clinical trials.","authors":"Roberto M Montorsi, Alessio Marchetti, Tessa E Hendriks, Freek Daams, Olivier R Busch, Bas Groot Koerkamp, Matteo De Pastena, Hjalmar C van Santvoort, Bert A Bonsing, Salvatore Paiella, Giuseppe Malleo, Marc G Besselink, Roberto Salvia","doi":"10.1093/bjsopen/zrag088","DOIUrl":"10.1093/bjsopen/zrag088","url":null,"abstract":"<p><strong>Background: </strong>The majority of postoperative morbidity and mortality after partial pancreatectomy is attributable to postoperative pancreatic fistula. Several interventions to prevent postoperative pancreatic fistula have been assessed in randomized clinical trials but consensus on their efficacy is lacking. This is the first systematic review and meta-analysis of randomized trials focusing on strategies to prevent postoperative pancreatic fistula after all types of partial pancreatectomy.</p><p><strong>Methods: </strong>Eligible randomized clinical trials assessing postoperative pancreatic fistula following partial pancreatectomy were included from the Evidence Map of Pancreatic Surgery database (2005-2025). As primary endpoint, both the 2005 and 2016 International Study Group for Pancreatic Surgery definitions of grade B/C postoperative pancreatic fistula were accepted. Interventions shown to reduce postoperative pancreatic fistula in at least one randomized trial were identified, and meta-analysis undertaken for those with at least three available trials, irrespective of their outcome.</p><p><strong>Results: </strong>Overall, 193 RCTs were included with 29 408 patients from 24 countries. The pooled rate of postoperative pancreatic fistula grade B/C was 15.1%: 14.2% after pancreatoduodenectomy and 19.1% after left pancreatectomy. Overall, 24 trials identified 18 interventions as effective in reducing the rate of postoperative pancreatic fistula: 11 intraoperative and 7 postoperative. Eight interventions were eligible for meta-analysis, involving 46 trials. Following meta-analysis, three interventions remained effective: drain omission in left pancreatectomy, perioperative use of somatostatin analogues, and administration of perioperative corticosteroids. The certainty of evidence was high for drain omission, moderate for somatostatin analogues, and low for corticosteroids. Eleven trials focused specifically on high-risk patients and four on ongoing postoperative pancreatic fistula. No trial combined interventions.</p><p><strong>Conclusion: </strong>Omission of drains in left pancreatectomy, perioperative use of somatostatin analogues, and administration of perioperative corticosteroids are effective strategies to prevent postoperative pancreatic fistula after partial pancreatectomy. However, current evidence remains immature and further RCTs evaluating these interventions are warranted, as they are likely to change the conclusions of subsequent meta-analyses. Such trials could potentially focus on high-risk patient cohorts and/or assess combinations of interventions.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13591280/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149011917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Environmental benefits of reintroducing reusable drapes and gowns in the operating room.","authors":"Florine I de Haes, Meis Uijttewaal, Nicolaas H Sperna Weiland, Martijn L M Broeren, Dorien A Salentijn","doi":"10.1093/bjsopen/zrag139","DOIUrl":"10.1093/bjsopen/zrag139","url":null,"abstract":"<p><strong>Background: </strong>The healthcare sector contributes significantly to environmental pollution, which adversely affects human health. Operating rooms are a major source of this impact, partially due to the routine use of disposable materials prepacked in surgical trays. The main objective of this study was to compare the environmental impacts of fully disposable surgical trays with those of hybrid surgical trays, which replace disposable drapes and gowns with reusable ones.</p><p><strong>Methods: </strong>This multicentre study included surgical trays from three types of surgeries: gynaecological laparoscopy surgery, extremity surgery, and caesarean section. This selection captures a broad range of surgical workflows and instrument requirements, enabling the development of an average tray composition and enhancing the generalizability of the findings across various surgical specialties. The hybrid trays, including reusable drapes and gowns, were developed and tested specifically for this study. A life cycle assessment was conducted according to ISO 14040/44 standards to compare the environmental impacts of the hybrid and disposable trays across 18 impact categories.</p><p><strong>Results: </strong>Hybrid trays demonstrated lower environmental impacts than disposable trays across almost all impact categories. For climate change, hybrid trays reduced impact by 40-51%. In disposable trays, drapes and gowns contributed to approximately 69% of the total climate change impact, whereas in hybrid trays this contribution decreased to 38%, primarily because the production and end-of-life impacts of reusable drapes and gowns are distributed over multiple uses.</p><p><strong>Conclusion: </strong>These results provide a robust evidence base to inform and support a broader European Union-wide transition to hybrid trays, incorporating reusable drapes and gowns, in operating rooms.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13591279/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149011860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Costs and health burden of surgical site infections and anastomotic leakage in major abdominal surgery.","authors":"Nathan Bontekoning, Hannah Groenen, Stijn W de Jonge, Markus W Hollmann, Marja A Boermeester, Marcel G W Dijkgraaf, Niels Wolfhagen","doi":"10.1093/bjsopen/zrag111","DOIUrl":"10.1093/bjsopen/zrag111","url":null,"abstract":"<p><strong>Background: </strong>Surgical site infection (SSI) is a common postoperative complication. SSI, including anastomotic leakage (AL), is a burden for patients and leads to increased costs, although insights as to the true costs from prospective data are limited. This study aimed to provide an overview of the impact of SSI and AL specifically on total societal costs and the quality of life (QoL) of patients.</p><p><strong>Method: </strong>This is a secondary analysis from the EPO2CH trial conducted between 2016 and 2020, which randomized patients scheduled for elective abdominal surgery with incisions > 5 cm to either standard care or standard care plus a bundle aiming to reduce SSI. Prospectively collected clinical data from the EPO2CH trial were used to ascertain the occurrence of SSI (superficial/deep/organ space and AL). The costs and QoL of patients with versus without SSI within 90 days after surgery were evaluated. The primary outcomes were costs (€) and (loss of) health utility, measured as quality-adjusted life-years (QALYs). QoL data were collected using patient questionnaires (EQ-5D™-3L). Unit costs were based on national guidelines for health economic evaluations and locally available unit costs of care.</p><p><strong>Results: </strong>Overall, 1119 of 1777 patients were analysed. Costs in the SSI and non-SSI groups were €53 562 (bias-corrected and accelerated (BCa) 95% confidence interval (c.i.) 45 356 to 68 600]) and €23 969 (BCa 95% c.i. 22 961 to 25 075), respectively, with a mean difference of €29 592 (BCa 95% c.i. 21 206 to 45 674). The greatest mean difference was observed between patients with AL and patients without SSI (€56 401; BCa 95% c.i. 39 487 to 90 892). The maximum attainable mean QALY score over 3 months was 0.25. The mean(standard deviation) QALY score in SSI and non-SSI patients was 0.171(0.050) and 0.205(0.037), respectively, with a mean difference of -0.035 (BCa 95% c.i. -0.042 to -0.029). This corresponds to a loss of 12.78 days in perfect health over the 3-month period.</p><p><strong>Conclusion: </strong>Patients with SSI, regardless of its type, had substantially higher healthcare costs and lower QoL after major abdominal surgery than patients without SSI.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621077/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":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.","authors":"Atsushi Kohyama, Shinobu Ohnuma, Yuichiro Tsukada, Michiaki Unno, Jun Watanabe, Yosuke Fukunaga, Yasumitsu Hirano, Kazuhiro Sakamoto, Hiroki Hamamoto, Masanori Yoshimitsu, Hisanaga Horie, Nobuhisa Matsuhashi, Yoshiaki Kuriu, Shuntaro Nagai, Madoka Hamada, Shinichi Yoshioka, Tamuro Hayama, Koki Otsuka, Yusuke Inoue, Kazuki Ueda, Yuji Toiyama, Satoshi Maruyama, Shigeki Yamaguchi, Keitaro Tanaka, Motoko Suzuki, Toshihiro Misumi, Takeshi Naitoh, Masahiko Watanabe, Masaaki Ito","doi":"10.1093/bjsopen/zrag128","DOIUrl":"https://doi.org/10.1093/bjsopen/zrag128","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>This exploratory supplemental analysis used data from Ultimate trial, a multicentre prospective phase II study across 47 Japanese institutions (2014-2017). Patients with cT1-2 N0 M0 ultra-low rectal cancer (≤ 5 cm from the anal verge) underwent laparoscopic resection. Tumour location was categorized as anterior (10-2 o'clock) or non-anterior (2-10 o'clock). The primary endpoint was LR; secondary endpoints included recurrence-free survival, overall survival, and stoma-free survival.</p><p><strong>Results: </strong>Of 300 enrolled patients, 297 were analysed (median follow-up 37.2 months); 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 < 0.001). Three-year recurrence-free survival (83.9% for anterior tumours versus 88.9% for non-anterior tumours; P = 0.222), overall survival (> 95%), and stoma-free survival were comparable between the two groups.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13626249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}