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Abstract Background Colorectal cancer (CRC) is the second most prevalent type of cancer in the world. Surgery is the only curative option. However, postoperative complications occur in up to 50% of patients and are associated with higher morbidity and mortality rates, lower health related quality of life (HRQoL) and increased expenditure in health care. The number and severity of complications are closely related to preoperative functional capacity, nutritional state, psychological state, and smoking behavior. Traditional approaches have targeted the postoperative period for rehabilitation and lifestyle changes. However, recent evidence shows that the preoperative period might be the optimal moment for intervention. This study will determine the impact of multimodal prehabilitation on patients’ functional capacity and postoperative complications. Methods/design This international multicenter, prospective, randomized controlled trial will include 714 patients undergoing colorectal surgery for cancer. Patients will be allocated to the intervention group, which will receive 4 weeks of prehabilitation (group 1, prehab), or the control group, which will receive no prehabilitation (group 2, no prehab). Both groups will receive perioperative care in accordance with the enhanced recovery after surgery (ERAS) guidelines. The primary outcomes for measurement will be functional capacity (as assessed using the six-minute walk test (6MWT)) and postoperative status determined with the Comprehensive Complication Index (CCI). Secondary outcomes will include HRQoL, length of hospital stay (LOS) and a cost-effectiveness analysis. Discussion Multimodal prehabilitation is expected to enhance patients’ functional capacity and to reduce postoperative complications. It may therefore result in increased survival and improved HRQoL. This is the first international multicenter study investigating multimodal prehabilitation for patients undergoing colorectal surgery for cancer. Trial registration Trial Registry: NTR5947 – date of registration: 1 August 2016.

Introduction: Anterior Cutaneous Nerve Entrapment Syndrome is allegedly caused by entrapment of an intercostal nerve in a fibrous ring in the rectus abdominis muscle leading to neuropathic pain. Surgical release of the strained nerve (neurectomy) obtains adequate pain relief in 70% of patients. Standard anatomy texts and previous research however might underestimate the complex network of nerve branches in the abdominal wall, leading to suboptimal treatment results and misguided pathophysiology. Material and methods: One fresh frozen cadaver with no gross previous pathology was dissected to map the course of intercostal nerves from the lateral abdominal wall to their nerve terminals in the subcutis of the anterior abdominal wall. Histology was performed to differentiate between nerve tissue and fascia. Special attention was payed to fibrous ring like structures. Results: Five major neurovascular bundles were identified (T8-T12). Fibrous rings were not found intramuscularly but in the posterior rectus sheath, if present. Multiple neural interconnections at the lateral border of the posterior rectus sheath were found. Per dermatome several small branches perforated the rectus abdominis muscle. Conclusions: The trajectory of nerves in the abdominal wall appears to be more complex than previously suggested, which should be addressed when for instance a neurectomy is performed. : The trajectory of nerves in the abdominal wall is more complex than previously suggested, which should be addressed when a neurectomy is performed in patients with Anterior Cutaneous Nerve Entrapment Syndrome (ACNES). Keywords: Intercostal nerve, Abdominal wall, Pain, ACNES, Entrapment, Neurectomy

Abstract Purpose  In a prospective, multi-institutional follow-up study we describe the trends in the preoperative pathologic confirmation of breast cancer of women who underwent breast cancer screening between 1995 and 2005. Methods  We included all women aged 50–75 years who underwent biennial screening mammography in the southern breast cancer screening region of the Netherlands between February 13, 1995 and December 22, 2004. Clinical data, breast imaging reports, biopsy results and breast surgery reports were collected of all women with a positive screening result. Follow-up lasted through the next biennial screening examination and was approximately two years for all referred women. Results  Of 258,900 mammographic screening examinations, 3,064 (1.2%) were positive screens. The majority of women (92%) were analyzed in four regional hospitals and workup yielded breast cancer in 1,332 women. From 1995 to 2005, the percentage of breast cancer cases that underwent percutaneous biopsy prior to surgery, increased from 42.4 to 100%. The proportion of cancers with a preoperative diagnosis of malignancy by percutaneous biopsy, increased from 27.1% in 1995 to 92.7% in 2004. Preoperative breast cancer confirmation by fine needle aspiration cytology (FNAC) gradually decreased from 91.3% to 14.5%, whereas preoperative confirmation by ultrasound guided core biopsy (USCB) or stereotactic core needle biopsy (SCNB) increased from 8.7% to 69.1% and from 0 to 17.4% respectively. Conclusions  A preoperative diagnosis of breast cancer is currently obtained in more than 90% of breast cancer patients. The increase in preoperative breast cancer diagnosis through 1995–2004 is correlated with the introduction of SNCB and increased use of USCB at the expense of FNAC. [ABSTRACT FROM AUTHOR]