ヤマグチ　シゲキ   YAMAGUCHI Shigeki   山口　茂樹    所属   医学部 医学科（東京女子医科大学病院）    職種   教授・基幹分野長
論文種別	原著
言語種別	英語
査読の有無	査読あり
表題	Patient-Reported Outcomes and Surgical Results of Hand-Sewn Versus Stapled Anastomosis for Lower Rectal Cancer Located 4-5 cm From the Anal Verge: A Subanalysis of the Ultimate Study
掲載誌名	正式名：Annals of gastroenterological surgery 略　 称：Ann Gastroenterol Surg ISSNコード：24750328/24750328
掲載区分	国外
巻・号・頁	9(6),pp.1215-1224
著者・共著者	NUMATA Masakatsu,WATANABE Jun,TSUKADA Yuichiro,SUWA Yusuke,FUKUNAGA Yosuke,HIRANO Yasumitsu,SAKAMOTO Kazuhiro,HAMAMOTO Hiroki,YOSHIMITSU Masanori,HORIE Hisanaga,MATSUHASHI Nobuhisa,KURIU Yoshiaki,NAGAI Shuntaro,HAMADA Madoka,YOSHIOKA Shinichi,OHNUMA Shinobu,HAYAMA Tamuro,OTSUKA Koki,INOUE Yusuke,UEDA Kazuki,TOIYAMA Yuji,MARUYAMA Satoshi,YAMAGUCHI Shigeki,TANAKA Keitaro,NAITOH Takeshi,WATANABE Masahiko,SUZUKI Motoko,MISUMI Toshihiro,ITO Masaaki
発行年月	2025/11
概要	BACKGROUND:Preserving anorectal function while achieving oncological success is crucial in the treatment of lower rectal cancer near the anal canal. Despite advancements in laparoscopic surgery that facilitate anal preservation, post-operative anorectal dysfunction considerably affects quality of life. Both hand-sewn and stapled anastomoses are suitable options for tumors located 4-5 cm from the anus. However, evidence comparing the functional outcomes and complications associated with both anastomosis methods is lacking.METHODS:This multicenter, single-arm prospective study included patients with cT1-T2/N0/M0 adenocarcinoma located 4-5 cm from the anal verge, scheduled for upfront laparoscopic surgery. Anorectal function, post-operative complications, urinary and male sexual function, and oncological outcomes were assessed using the validated scores.RESULTS:A total of 135 patients were analyzed and divided into hand-sewn (n = 65) and stapled (n = 70) groups. The patient characteristics were similar, except for the tumors in the hand-sewn group located 1 mm closer to the anal verge. No significant differences were observed in the post-operative complications. Anorectal function, measured using Wexner scores, worsened at 3 months postoperatively and gradually improved in both groups. At 3, 6, 12, 24, and 36 months, the stapled group consistently showed better Wexner scores than the hand-sewn group. Urinary function, sexual function, and oncological outcomes were similar in both groups.CONCLUSION:Stapled anastomosis may provide better anorectal function with comparable safety and oncological outcomes to hand-sewn anastomosis. Therefore, stapled anastomosis may be preferred for tumors located 4-5 cm from the anal verge to ensure oncological safety.TRIAL REGISTRATION:This study was registered in the UMIN Clinical Trials Registry System (UMIN 000011750).
DOI	10.1002/ags3.70063
PMID	41199980