Abstract Background Early‐onset colorectal cancer (EOCRC; diagnosed <50 years) incidence is increasing globally; however, understanding of the epidemiology remains limited. We compared and contrasted EOCRC incidence patterns in England during 2012–2021 with late‐onset colorectal cancer (LOCRC; ≥50 years). Methods All primary colorectal cancer (CRC) cases (351,900) were identified from the English National Cancer Registration Database. Percentages and age‐standardised incidence rates were calculated by socio‐demographic and geographical variables, tumour subsite, stage and route to diagnosis. Trends were assessed for 2012–2021, two quinquennia (2012–2016; 2017–2021) and COVID‐19 pandemic‐specific periods (1/1/2012–31/3/2020; 1/4/2020–31/12/2021). Incidence rate ratios (IRR) were derived using Poisson regression. Results EOCRC accounted for 6% of CRC. Whilst more males were diagnosed with LOCRC (55.9%), EOCRC incidence varied little by sex. EOCRC incidence increased over time. The COVID‐19 pandemic was associated with a brief (~6 month) disruption in incidence trends for both EOCRC and LOCRC. For EOCRC, incidence of advanced stage disease rose markedly from 2012–2016 to 2017–2021 (IRR = 1.21 (1.16, 1.25)); incidence of both early and advanced‐stage LOCRC fell slightly over time (early‐stage IRR = 0.99 (0.98, 1.00); advanced‐stage IRR = 0.97 (0.96, 0.98)). A greater proportion of EOCRC (25.4%) were diagnosed as emergencies compared with LOCRC (20.2%). Regional variations were minimal for EOCRC but more pronounced for LOCRC. Conclusion EOCRC incidence continues to rise and displays distinct epidemiological features compared to LOCRC. Higher rates of advanced disease, more frequent emergency diagnosis, and the sharpest increases in the youngest adults underscore growing challenges for timely detection and diagnosis.
Abstract Introduction Emergency General Surgery is a common reason for an emergency admission in the UK with over 25,000 emergency laparotomies (EmLap) performed every year.(1) For frail and co‐morbid patients an alternative decision is often made that not undergoing surgery is in their best interest (NoLap). For both EmLap and NoLap patients, little is known about survivorship. This study aims to quantify quality of life (QoL) for EmLap and NoLap patients and explore the decision‐making process. Methods and Analysis PERI‐SCOPES is a mixed‐methods multicentre study exploring QoL and decision‐making in Emergency General Surgery. The study will involve two separate workstreams. Workstream 1 Up to 30 patients, EmLap or NoLap, will be eligible for inclusion and identified by the local research teams. Patients will be recruited from six sites across Scotland. Patients will be invited to nominate a family member/supporter to participate alongside them. Participants will complete validated QoL questionnaires within 4 weeks of EmLap/NoLap decision then again at 3‐ and 9–12 months post‐decision. Questionnaires will include EuroQol five‐dimension five‐level, Short Form of the Profile of Mood States, International Trauma Questionnaire and Caregiver Strain Index. Patients and their family member/supporter will also take part in three semi‐structured interviews at similar time‐points to explore their experience of decision‐making. Workstream 2 UK‐based consultant decision‐makers (surgeons, anaesthetists and intensivists) will be invited to complete an online survey exploring personality, risk‐taking and decision‐making in Emergency General Surgery. At least 52 consultants will be recruited to ensure sufficient statistical power. Individual semi‐structured interviews will be conducted with up to 20 consultants to allow a deeper exploration of decision‐making. Ethics and Dissemination PERI‐SCOPES is sponsored by The University of Glasgow and has received ethical approval from East of Scotland REC (25/ES/0015). This study has Research and Innovation (R&I) approval from NHS Greater Glasgow and Clyde, Grampian, Tayside and Lothian (6 hospital sites). We aim to disseminate results via peer‐reviewed medical journals and conferences. Trials Registration Number NCT06972017.
Abstract Introduction Parastomal hernia (PSH) is a common complication of stoma formation, and there is no consensus on the optimal surgical treatment of this challenging condition. In this technical note, our aim is to describe a novel approach by carrying out a Pauli repair through the stoma, thereby avoiding a midline laparotomy, and to evaluate its outcomes in a case series. Methods We provide a description and video of the technical steps of this novel approach. In addition, we carried out a retrospective single‐centre case series of six consecutive elective patients treated with this technique for PSH without a midline component and their immediate procedural outcomes (recurrence and complications). Results Six patients with a mean age of 56.8 years (range 39–72 years) and a mean BMI of 30.3 kg/m 2 underwent this modified Pauli repair between 2023 and 2025. Three patients (50%) had European Hernia Society (EHS) type III hernias. Median length of stay was 3.5 days (IQR 3–4.75). There were no Clavien Dindo ≥4 complications but a high rate (50%) of wound complications. We observed no clinical recurrences at a median follow‐up time of 13.6 months (IQR 7.9–20.2 months). Discussion Our modification of the Pauli technique for hernias without a midline component is feasible with promising short‐term results in patients with an ileal conduit. Further evaluation in larger cohorts with longer follow‐up is required to establish the safety and durability of this approach. Originality Statement This paper describes the feasibility of carrying out a Pauli repair of parastomal hernia via a local approach through the stoma, thereby avoiding the morbidity of a laparotomy in patients without a midline component. Further evaluation in larger cohorts with longer follow‐up is required to establish the safety and durability of this approach.
