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This is a narrative review examining molecular mechanisms of replication stress tolerance in ATL; it synthesizes existing knowledge and proposes mechanistic hypotheses rather than presenting original experimental results or clinical trial data.
A retrospective cohort study with adequate sample size and long follow-up (median 63 months) reporting a clinically meaningful primary endpoint (delayed re-stoma-free survival), but lacks a comparator group and prospective design; results support the durability of sphincter-preserving surgery but require confirmation in prospective studies.