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INTRODUCTION: With evolving treatment strategies aiming at prevention or early detection of metachronous peritoneal metastases (PM), identification of high-risk colon cancer patients becomes increasingly important. This study aimed to evaluate differences between pT4a (peritoneal penetration) and pT4b (invasion of other organs/structures) subcategories regarding risk of PM and other oncological outcomes. MATERIALS AND METHODS: From eight databases deriving from four countries, patients who underwent curative intent treatment for pT4N0-2M0 primary colon cancer were included. Primary outcome was the 5-year metachronous PM rate assessed by Kaplan-Meier analysis. Independent predictors for metachronous PM were identified by Cox regression analysis. Secondary endpoints included 5-year local and distant recurrence rates, and 5-year disease free and overall survival (DFS, OS). RESULTS: In total, 665 patients with pT4a and 187 patients with pT4b colon cancer were included. Median follow-up was 38 months (IQR 23-60). Five-year PM rate was 24.7% and 12.2% for pT4a and pT4b categories, respectively (p = 0.005). Independent predictors for metachronous PM were female sex, right-sided colon cancer, peritumoral abscess, pT4a, pN2, R1 resection, signet ring cell histology and postoperative surgical site infections. Five-year local recurrence rate was 14% in both pT4a and pT4b cancer (p = 0.138). Corresponding five-year distant metastases rates were 35% and 28% (p = 0.138). Five-year DFS and OS were 54% vs. 62% (p = 0.095) and 63% vs. 68% (p = 0.148) for pT4a vs. pT4b categories, respectively. CONCLUSION: Patients with pT4a colon cancer have a higher risk of metachronous PM than pT4b patients. This observation has important implications for early detection and future adjuvant treatment strategies. ispartof: EJSO vol:47 issue:9 pages:2405-2413 ispartof: location:England status: published

Anastomotic Leakage is a severe complication after Low Anterior Resection (LAR) for rectal cancer and occurs in up to 20% of patients. Most research focusses on reducing incidence and predictive factors of anastomotic leakage. There are no robust data on severity and treatment strategies with associated outcomes.

ESGE recommends that individuals with hereditary gastrointestinal polyposis syndromes should be surveilled in dedicated units that provide monitoring of compliance and endoscopic performance measures. Strong recommendation, moderate quality of evidence, level of agreement 90 %.ESGE recommends performing esophagogastroduodenoscopy, small-bowel examination, and/or colonoscopy earlier than the planned surveillance procedure if a patient is symptomatic. Strong recommendation, low quality of evidence, level of agreement 100 %.

Background The effects of neoadjuvant radiotherapy on healing of the rectal stump after a Hartmann procedure for rectal cancer are unknown. Objective The purpose of this study was to analyze the impact of radiotherapy on postoperative complications after a Hartmann procedure for rectal cancer at a population level. Design This was a population-based observational study. Postoperative outcomes were compared between Hartmann procedures with and without radiotherapy. Risk factors for postoperative intra-abdominal abscess requiring reintervention, any reintervention, and 30-day or in-hospital mortality were analyzed using a multivariable model. Settings The study included in-hospital registration for the Dutch Surgical Colorectal Audit. Patients Patients with rectal cancer who underwent a Hartmann procedure (total or partial mesorectal excision with end colostomy) between 2009 and 2013 were included. Main outcome measures Abdominal abscess requiring reintervention, any reintervention, and 30-day or in-hospital mortality were measured. Results Of 1728 patients who underwent a Hartmann procedure for rectal cancer, 90.5% (n = 1563) received preoperative radiotherapy. Intra-abdominal abscess formation was significantly increased after radiotherapy (7.0% vs 3.0%; p = 0.049). Overall reinterventions (15.2% vs 15.4%; p = 0.90) and 30-day mortality (2.4% vs 3.5%; p = 0.48) were not associated with radiotherapy in univariable analysis. In multivariable analysis, radiotherapy was an independent predictor of postoperative intra-abdominal abscess requiring reintervention (OR, 2.81 (95% CI, 1.01-7.78)) but was not associated with overall reinterventions or mortality. Limitations This study was limited by the data being self-reported. Case-mix adjustment was limited to information available in the data set, and no long-term outcome data were available. Conclusions Based on these population-based data, radiotherapy is independently associated with an increased risk of postoperative intra-abdominal abscess requiring reintervention after Hartmann procedure for rectal cancer. This finding is relevant for patient-tailored postoperative care but should probably not influence indication for radiotherapy, because it did not affect overall reinterventions and mortality (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A193).

Item does not contain fulltext BACKGROUND: Case series suggest that laparoscopic peritoneal lavage might be a promising alternative to sigmoidectomy in patients with perforated diverticulitis. We aimed to assess the superiority of laparoscopic lavage compared with sigmoidectomy in patients with purulent perforated diverticulitis, with respect to overall long-term morbidity and mortality. METHODS: We did a multicentre, parallel-group, randomised, open-label trial in 34 teaching hospitals and eight academic hospitals in Belgium, Italy, and the Netherlands (the Ladies trial). The Ladies trial is split into two groups: the LOLA group comparing laparoscopic lavage with sigmoidectomy and the DIVA group comparing Hartmann's procedure with sigmoidectomy plus primary anastomosis. The DIVA section of this trial is still underway but here we report the results of the LOLA section. Patients with purulent perforated diverticulitis were enrolled for LOLA, excluding patients with faecal peritonitis, aged older than 85 years, with high-dose steroid use (>/=20 mg daily), and haemodynamic instability. Patients were randomly assigned (2:1:1; stratified by age [/=60 years]) using secure online computer randomisation to laparoscopic lavage, Hartmann's procedure, or primary anastomosis in a parallel design after diagnostic laparoscopy. Patients were analysed according to a modified intention-to-treat principle and were followed up after the index operation at least once in the outpatient setting and after sigmoidoscopy and stoma reversal, according to local protocols. The primary endpoint was a composite endpoint of major morbidity and mortality within 12 months. This trial is registered with ClinicalTrials.gov, number NCT01317485. FINDINGS: Between July 1, 2010, and Feb 22, 2013, 90 patients were randomly assigned in the LOLA section of the Ladies trial when the study was terminated by the data and safety monitoring board because of an increased event rate in the lavage group. Two patients were excluded for protocol violations. The primary endpoint occurred in 30 (67%) of 45 patients in the lavage group and 25 (60%) of 42 patients in the sigmoidectomy group (odds ratio 1.28, 95% CI 0.54-3.03, p=0.58). By 12 months, four patients had died after lavage and six patients had died after sigmoidectomy (p=0.43). INTERPRETATION: Laparoscopic lavage is not superior to sigmoidectomy for the treatment of purulent perforated diverticulitis. FUNDING: Netherlands Organisation for Health Research and Development.