Abstract Introduction In patients with perforated diverticulitis, Hinchey III, health economics analyses from randomized controlled trials have shown cost-benefits for laparoscopic lavage compared to resection surgery. The aim was to compare costs in routine care within a three-year national Swedish cohort. Methods Healthcare consumption (hospitalization, operations, days with stoma) from emergency surgery to two years postoperatively was compared for patients treated with laparoscopic lavage versus resection in Sweden 2016–2018, identified by in-patient registry and medical charts. Costs were valued by national prices for operations, regional health care price lists, and the literature. A double-robust weighted regression analysis was used. The groups (lavage n = 173, resection n = 291) were balanced with propensity score with inverse probability weighting and adjustment of the same factors. Costs were expressed in Swedish Krona (SEK) year 2020 and discounted 3%. Deterministic sensitivity analyses were implemented. Results Average total two-year healthcare costs were 195 500 SEK for laparoscopic lavage and 300 500 SEK for resection surgery. Weighted group cost-saving for patients treated initially by lavage with 63 000 SEK (95% c.i. −99 640: −26 290; P 0.001). Stoma-related costs represented the major cost difference; −22 870 SEK (95% c.i. −26 570: −19 170; P < 0.000). The lavage procedure was cost-saving compared to resection in sensitivity analyses of plausible cost ranges. Discussion The results from this national routine care cohort confirmed results from randomized trials, with lavage being cost-efficient as treatment for perforated diverticulitis with purulent peritonitis. Using lavage to a greater extent would be economically beneficial in a Swedish context.

ABSTRACT Objective The objective of this study is to explore effects on self‐reported fatigue at 4 weeks and 12 months after surgery in patients with colorectal cancer undergoing a pre‐ and postoperative exercise intervention compared to standard care in a randomized trial. Background Fatigue after cancer surgery is common and evidence suggests it could be alleviated by physical activity. In this post hoc exploratory study, we analyzed fatigue and other secondary outcomes from a randomized trial aimed at exploring if prehabilitation by additional physical activity could improve postoperative recovery. Method PHYSSURG C was a multicenter, controlled, randomized trial. Patients diagnosed with colorectal cancer were randomized to additional unsupervised moderate physical exercise in accordance with WHO guidelines or usual care two weeks before and four weeks after surgery. Trial‐specific questionnaires were used at baseline, at 4 weeks and 12 months. Outcomes were self‐reported fatigue as well as quality of life, pain, and mental recovery at both postoperative follow‐up times. Results A total of 518 patients were included in this analysis. At 4 weeks after surgery, the mean difference in fatigue was 3.75 ((CI 0.01;7.49), p = 0.05) with intention to treat approach, and in a per protocol analysis at 4 weeks the mean difference was 4.04 ((CI 0.14;7.93), p = 0.04), and at 12 months it was 4.29 ((CI 0.44; 8.14), p = 0.03). There were no differences between the intervention and control groups regarding quality of life, pain, or mental recovery. Conclusion This exploratory study found a suggestion of less postoperative fatigue in the intervention group. Further studies are needed to define the role of unsupervised moderate exercise, if any, before and after surgery in regard to postoperative fatigue in patients with colorectal cancer. Trial Registration ClinicalTrials.gov identifier: NCT02299596

Background: To investigate whether individualised, peri-operative, activity counselling vs. standard advice increases activity after bariatric surgery, we conducted a randomised controlled trial. The trial was prematurely terminated due to slow recruitment and high non-completion rate. We report some emergent findings: physical activity levels pre-operatively and eight and 52weeks post-operatively; and of risk models for participants who achieved the physical activity goal and for participants who completed the study. Methods: Of 269 participants, 132 were randomised to the intervention and 137 to the control group. The intervention group received individualised counselling to increase physical activity perioperatively. The control group received standard advice. The primary dependent variable was self-reported physical activity level. Results: No differences were observed in physical activity levels between groups. The factor that most impacted participants' achievement of the activity goal eight weeks post-operatively was being at goal pre-operatively. Regarding study completion, older age increased and smoking decreased the odds. Conclusion: From this prematurely terminated and thus underpowered trial, it was not possible to establish an intervention effect. Nonetheless, the study contributes by identifying factors associated with adherence and barriers to activity programs by individuals who are obese, providing useful information for the future design of related interventions.

BACKGROUND:Frailty is known to adversely affect post-operative mortality and morbidity following colorectal cancer resection, but its impact on long-term quality of life and functional outcomes after colon cancer surgery is less clear. This study aims to evaluate the impact of frailty at the time of diagnosis on quality of life, impact on daily activities, and contentment with treatment one year after colon cancer resection. METHOD:Data were obtained from the prospective, multicentre Quality of Life in Colon Cancer (QoLiCOL) study. Patients aged ≥70 years who underwent colon cancer surgery in Region Västra Götaland, Sweden, were collected from the QoLiCOL database (n = 347). Clinical data were retrieved from national quality registries. Frailty was retrospectively assessed by reviewing medical records using the Clinical Frailty Scale-9 (CFS-9), with scores ≥4 classified as frail. Outcomes included self-reported quality of life, treatment-related impact on activities of daily living, and treatment satisfaction one year post-operatively. Directed Acyclic Graphs (DAGs) of variables known to affect the outcome variables were made before analyses, and potential confounders were adjusted for in the final analyses. Comparisons between frail and non-frail groups were performed using ordinal logistic regression and logistic regression, with results reported as odds ratios (OR). RESULTS:The prevalence of frailty in the cohort was 29%, with a median CFS-9 value of 4 (range 4-6) in the frail group, indicating very mild to moderate frailty. No significant differences were observed between frail and non-frail older adults in self-assessed quality of life, treatment-related impact on daily activities or treatment satisfaction one year after surgery. Notably, both groups reported improved quality of life at one year compared with baseline. Only a small proportion of participants (n = 8; 2%) reported not being content with their treatment. CONCLUSION:Among older adults who were alive one year after colon cancer surgery, mild to moderate frailty does not appear to negatively influence long-term quality of life, effect on daily activities, or satisfaction with treatment. Frail and non-frail patients reported similar levels of well-being and contentment with their care one year post-operatively.

Background and purpose: Pain as a long-term outcome following rectal cancer treatment has received limited attention in previous studies. This prospective cohort study examined pain prevalence up to 5 years post-surgery in patients treated with curative intent. Secondary aims included evaluating pain intensity and its interference with daily life, and comparing pain experiences with a reference population. In addition, potential risk factors for pain were explored. Patient/material and methods: The study is based on the multicenter prospective cohort study QoLiRECT including patients from 16 surgical departments in Denmark and Sweden (2012–2015). Questionnaires regarding Quality of Life were administered at diagnosis and at 1, 2 and 5 years after treatment. Information about self-assessed pain was primarily derived from the ‘Brief Pain Inventory – Short Form’. Comparisons were made with an age- and sex- matched reference population. Results: Five years post-treatment, 37% of rectal cancer survivors reported pain exceeding common types of pain, with an average pain level of 3.8 and interference score of 3.1 (range 0–10). Pain was mainly located to the lower extremities, back and pelvis. Surprisingly, pain prevalence was higher in the reference population (53%), a difference consistent at all time points. No significant difference was found between groups regarding average pain or interference. Higher pain levels were associated with female sex, severe baseline pain, and elevated Body Mass Index (BMI). Interpretation: Pain was more common in the reference population, while intensity and interference were similar between groups. This suggests that the experience of pain may differ after surviving cancer, and such differences might be considered when studying pain in cancer survivors.

Abstract Introduction Laparoscopic lavage is an established alternative to resection in perforated diverticulitis with purulent peritonitis, but the mechanism of action remains unclear. It is unknown whether its effect is primarily explained by mechanical washout or influenced by procedural factors such as insufflation gas, lavage fluid, and intra-abdominal pressure. This study aimed to determine the relative contribution of lavage and procedural factors to the early peritoneal inflammatory response. Methods In a controlled experimental study, 110 rats with cecal ligation and puncture–induced peritonitis, with 15 sham controls, were randomized to lavage or no lavage, with variation in gas (carbon dioxide versus helium), fluid (saline versus buffered solution), and pressure (2 versus 8 mmHg). Peritoneal fluid and serum were analyzed 1-hour post-intervention using a 92-protein panel. Proteomic patterns were assessed using principal component analysis (PCA), and differential protein abundance was evaluated using mixed linear models. Results In peritoneal fluid, PCA showed clear separation between lavage-treated and non-lavaged animals, independent of gas, fluid, or pressure. Lavage was associated with a broad reduction in inflammatory protein levels, including cytokines, chemokines, and growth factor signalling proteins, while only a few proteins increased. In serum, no separation was observed. Discussion Lavage was the dominant driver of reduced peritoneal inflammatory protein levels, with no clear effect of procedural factors. The findings support mechanical clearance as the primary mechanism and indicate that lavage is robust across procedural settings. They also suggest that lavage volume may be an important determinant of treatment effect.

BACKGROUND AND AIMS:The Swedish ColoRectal Cancer Registry (SCRCR) includes data on patients with rectal cancer in Sweden with a coverage rate of 98.5%. Variables on primary diagnosis and treatment have good validity, but the validation of oncological outcomes such as local recurrence is lacking. Since data from the SCRCR are used widely in research and for clinical evaluation, with local recurrence as an important outcome, this study aimed to validate the registration of local recurrence of rectal cancer in the SCRCR. METHODS:All patients registered with a diagnosis of rectal cancer in 2016 and 2017 who underwent an abdominal resection of the tumor were identified in the SCRCR. Medical records were reviewed and compared to the data registered in the SCRCR. RESULTS:A total of 2828 patients were included, of which 166 patients (5.9%) were diagnosed with local recurrence according to medical records within the study period. Of these, 94/166 (57%) were registered with local recurrence in the SCRCR. Patients with non-reported local recurrence more often had concurrent metastases and/or were treated with palliative intent. There were 17 patients reported with local recurrence in the SCRCR without local recurrence identified in the medical records. CONCLUSION:There was a significant underreporting of local recurrence in the SCRCR. Ambiguities in the definition of local recurrence as well as disregarding patients with concurrent metastatic disease probably contributed to the underreporting. Clarifying the definition of local recurrence and stressing the importance of reporting local recurrence regardless of metastatic disease or palliative treatment may improve data accuracy.

The SCRCR has a high coverage rate and good validity on variables regarding diagnosis and treatment of rectal cancer. As data from the SCRCR are used extensively in research and clinical quality evaluation with tumour recurrence as an important outcome, it is of essence to validate these variables. The aim of this study was to validate the registration of metachronous metastases of rectal cancer in the SCRCR. All patients registered with a diagnosis of rectal cancer between 2016 and 2017 who underwent abdominal resection of the rectal tumour were identified in the SCRCR. Medical charts were reviewed until end of follow-up June 30th, 2022. Patients with synchronous metastases, who were never tumour-free following surgery of the primary rectal tumour, were excluded. Of a total of 4211 patients registered with a diagnosis of rectal cancer, 2824 patients had an abdominal resection of the rectal tumour and available medical charts. Of these, 2754 patients (97.5%) were regarded as tumour free at some point following resection of the primary rectal tumour. Metachronous metastases were diagnosed in 591 of these patients (21.5%). In 499 patients (84.4%) the metachronous metastases were registered in the SCRCR. For an additional 53 patients registered with metachronous metastases in the SCRCR no metastases were identified in the medical records, which constitutes 9.6% of registered cases. There was a moderate underreporting of metachronous metastases in the SCRCR, why the procedures for reporting to the registry may need to be reviewed.

BACKGROUND AND OBJECTIVE:Localized prostate cancer can be treated with either robot-assisted laparoscopic prostatectomy (RALP) or open retropubic radical prostatectomy (RRP). This study aimed to analyze all-cause and prostate cancer-specific mortality 12 yr after surgery. METHODS:The nonrandomized multicenter LAParoscopic Prostatectomy Robot Open (LAPPRO) trial enrolled patients from 2008 to 2011. The eligibility criteria included age <75 yr, prostate-specific antigen <20 ng/ml, clinical stage <T4, nonmetastatic disease, and informed consent. Data were collected through validated questionnaires at baseline and clinical record forms repeatedly up to 12 yr after surgery, with mortality information retrieved from Sweden's National Cause of Death Register. The main outcomes were all-cause and prostate cancer-specific mortality. KEY FINDINGS AND LIMITATIONS:Of the 4003 patients enrolled in LAPPRO, 3583 were eligible for the current analysis, of whom 2698 (75%) underwent RALP and 885 (25%) RRP. At 12 yr after surgery, prostate cancer-specific mortality was significantly lower after RALP than after RRP (55/2698 [2.0%] vs 40/885 [4.5%]; adjusted hazard ratio [HR] 0.36, 95% confidence interval [CI] 0.23-0.55). The numbers of all-cause deaths were 371/2698 (14%) in the RALP group and 145/885 (16%) in the RRP group (adjusted HR 0.81, 95% CI 0.66-0.99). The study is limited by its nonrandomized design. CONCLUSIONS AND CLINICAL IMPLICATIONS:At 12 yr after surgery, prostate cancer-specific mortality was significantly lower in patients undergoing robotic prostatectomy than in those undergoing open prostatectomy. Cautious interpretation is suggested for the possible causal effect, but the results suggest that the robotic technique is associated with a better oncological outcome.

The objective was to explore if adverse events during radical prostatectomy for prostate cancer were associated with oncological outcomes. A further objective was to identify risk factors for adverse events. A post-hoc study nested in a prospective, controlled trial of radical prostatectomy by robot assisted laparoscopic or open retropubic approach in Sweden. Adverse events during surgery were collected from clinical record forms (CRFs) filled out by the surgeon at operation. Recurrence was identified from CRFs and patient reports, cause of death through the Swedish National Cause of Death Register. Recurrence was defined as undetectable PSA 6–12 weeks after prostatectomy followed by PSA > 0.25 ng/ml or treatment for prostate cancer recurrence. Cox regression was used to explore associations between exposure and outcome. One/more adverse events occurred during 39

OBJECTIVE:To estimate the minimal important difference (MID) of the Comprehensive Complication Index (CCI ® ) in patients undergoing abdominal surgery. BACKGROUND:The CCI ® is a validated metric that quantifies cumulative surgical morbidity. While the CCI ® is a sensitive endpoint to detect treatment effects, a statistically significant effect does not necessarily translate into clinical relevance. Relevant differences from the patients' perspective are best captured by the MID. METHODS:Individual patient data were extracted from surgical studies reporting CCI ® at 30 days and using patient-reported outcome measures with established MIDs at baseline and 30 days. To determine the MID for the CCI ® , we used an anchor-based approach as recommended by methods guidelines. A patient-reported outcome measure was selected as an anchor only if the Spearman correlation coefficient between its change in score (baseline to 30 days postoperative) and the CCI ® was ≥|0.30|. We used linear regression to estimate the MID of the CCI ® across different anchors, and triangulation to determine a single MID. RESULTS:Data were extracted from 3 published randomized controlled trials and 1 prospective observational study (n = 1583 patients) in major abdominal surgery. In colorectal surgery cohorts, 2 subscores of the Short Form-36, 2 subscores of the Multidimensional Fatigue Inventory-20, the EuroQol-5-Dimension Index Score, and the EuroQol Visual Analog Scale showed a correlation with the CCI ® of ≥|0.30|. This resulted in MID estimates for the CCI ® ranging from 6.1 to 22.2. In hepato-pancreato-biliary surgery, 1 subscore of the Short Form-36, and 2 subscores of the Patient Reported Outcome Measure Information System-29 questionnaire qualified as anchors providing MID estimates ranging from 6.2 to 13.8. CONCLUSIONS:We propose a mean difference of 12 points in the CCI ® between treatment groups as a relevant difference in patients undergoing abdominal surgery. This MID provides an important foundation for sample size calculations and interpretation of randomized controlled trials and large real-world observational studies.

To estimate the minimal important difference (MID) of the Comprehensive Complication Index (CCI®) in patients undergoing abdominal surgery. The CCI® is a validated metric that quantifies cumulative surgical morbidity. While the CCI® is a sensitive endpoint to detect treatment effects, a statistically significant effect does not necessarily translate into clinical relevance. Relevant differences from the patients’ perspective are best captured by the MID. Individual patient data were extracted from surgical studies reporting CCI® at 30 days and using patient-reported outcome measures with established MIDs at baseline and 30 days. To determine the MID for the CCI®, we used an anchor-based approach as recommended by methods guidelines. A patient-reported outcome measure was selected as an anchor only if the Spearman correlation coefficient between its change in score (baseline to 30 days postoperative) and the CCI® was ≥|0.30|. We used linear regression to estimate the MID of the CCI® across different anchors, and triangulation to determine a single MID. Data were extracted from 3 published randomized controlled trials and 1 prospective observational study (n = 1583 patients) in major abdominal surgery. In colorectal surgery cohorts, 2 subscores of the Short Form-36, 2 subscores of the Multidimensional Fatigue Inventory-20, the EuroQol-5-Dimension Index Score, and the EuroQol Visual Analog Scale showed a correlation with the CCI® of ≥|0.30|. This resulted in MID estimates for the CCI® ranging from 6.1 to 22.2. In hepato-pancreato-biliary surgery, 1 subscore of the Short Form-36, and 2 subscores of the Patient Reported Outcome Measure Information System-29 questionnaire qualified as anchors providing MID estimates ranging from 6.2 to 13.8. We propose a mean difference of 12 points in the CCI® between treatment groups as a relevant difference in patients undergoing abdominal surgery. This MID provides an important foundation for sample size calculations and interpretation of randomized controlled trials and large real-world observational studies.

The risk of developing chronic abdominal pain after Roux-en-Y gastric bypass (RYGB) surgery has come under scrutiny. Few prospective studies exist on this subject. The aim of this prospective paired analysis cohort study was to evaluate the risk of developing chronic abdominal pain and QoL 2 years after RYGB surgery. An unselected cohort of 107 patients living with obesity, scheduled to undergo elective RYGB surgery, filled out the study questionnaires before surgery. Two years after surgery, 84 patients responded to the questionnaires, resulting in a response rate of 78.5

BACKGROUND:The main surgical resection options in rectal cancer are anterior resection for tumors in the mid- or upper rectum and abdominoperineal excision for tumors in the lower rectum. A previous study showed long-term persistent perineal symptoms and sitting difficulties after abdominoperineal excision. OBJECTIVE:To examine the prevalence and extent of sitting and walking difficulties after abdominoperineal excision compared with anterior resection. DESIGN:An observational, prospective, longitudinal, multicenter, international study. SETTINGS:Data were collected from participants in the quality of life in rectal cancer study. Participants answered questionnaires about bodily functions, symptoms, and quality of life at baseline and at 1 and 2 years after diagnosis. PATIENTS:Patients with newly diagnosed rectal cancer, regardless of stage, were included. The study included 1024 patients, of whom 64% underwent anterior resection and 36% underwent abdominoperineal excision. MAIN OUTCOME MEASURES:The primary objective was to estimate the prevalence and ORs of sitting or walking difficulties between the 2 surgical procedure groups: abdominoperineal excision and anterior resection. RESULTS:In the group of patients who underwent abdominoperineal excision, 29% had sitting difficulties after 2 years compared with 12% in the group who underwent anterior resection (OR, 2.65; 95% CI, 1.71-4.09; p < 0.0001). Walking difficulties after 2 years were reported by 35% after abdominoperineal excision compared with 24% after anterior resection (OR, 1.50; 95% CI, 1.02-2.22; p = 0.04). LIMITATIONS:The observational nature of the study could be regarded as a limitation. CONCLUSIONS:Abdominoperineal excision was associated with both sitting and walking difficulties among patients with rectal cancer at significantly higher rates compared with anterior resection. It is probable that attention from health care could improve the situation of the patients through enhanced rehabilitation. See Video Abstract . CLINICAL TRIAL REGISTRATION:ClinicalTrials.gov (NCT01477229). DIFICULTADES PERSISTENTES PARA SENTARSE Y CAMINAR POSTERIOR A LA ESCISIN ABDOMINOPERINEAL Y RESECCIN ANTERIOR RESULTADOS DEL ESTUDIO QOLIRECT:ANTECEDENTES:Las principales opciones de resección quirúrgica en el cáncer de recto son la resección anterior para los tumores en el recto medio o superior y la escisión abdominoperineal para los tumores en el recto inferior. Un estudio previo mostró síntomas perineales persistentes a largo plazo y dificultades para la sedestación posterior a la escisión abdominoperineal.OBJETIVO:Examinar la prevalencia y el grado de dificultades para sentarse y caminar después de la escisión abdominoperineal en comparación con la resección anterior.DISEÑO:Estudio observacional, prospectivo, longitudinal, multicéntrico e internacional.ESTABLECIMIENTOS:Se recopilaron datos de los participantes en el estudio QoLiRect. Los participantes respondieron cuestionarios sobre funciones corporales, síntomas y calidad de vida al inicio y tras 1 y 2 años posterior al diagnóstico.PACIENTES:Se incluyeron pacientes con cáncer de recto de reciente diagnóstico independientemente del estadio. El estudio incluyó a 1024 pacientes, de los cuales el 64 % fueron sometidos a una resección anterior y el 36 % a una escisión abdominoperineal.PRINCIPALES MEDIDAS DE RESULTADOS:El objetivo principal fue estimar la prevalencia y los odds ratios (OR) de dificultades para sentarse o caminar entre los dos grupos de procedimientos quirúrgicos: escisión abdominoperineal y resección anterior.RESULTADOS:En el grupo de pacientes sometidos a la escisión abdominoperineal, el 29% tenía dificultades para sentarse tras 2 años posterior a la cirugía en comparación con el 12% en el grupo que fue sometido a resección anterior (OR 2,65, IC del 95% 1,71-4,09, p < 0,0001). Las dificultades para caminar posterior a los 2 años se informaron en el 35% después de la escisión abdominoperineal en comparación con el 24% después de la resección anterior (OR 1,50, IC del 95% 1,02-2,22, p = 0,04).LIMITACIONES:La naturaleza observacional del estudio podría considerarse una limitación.CONCLUSIONES:La escisión abdominoperineal se asoció con dificultades para sentarse y caminar en pacientes con cáncer rectal con tasas significativamente mayores en comparación con la resección anterior. Es probable que la atención médica pueda mejorar la situación de los pacientes mediante una mejor rehabilitación. (Traducción-Dr Osvaldo Gauto ).

BACKGROUND AND PURPOSE:Anal cancer is treated with chemoradiotherapy and with salvage surgery in case of local failure. Curation rate depends on tumour stage but is overall high (80-90%). This study explored anal cancer survivors' perception of being cured and possible association with Quality of Life (QoL). Secondary aims were to explore fear of recurrence and if perception of cure changed over time or differed depending on tumour stage. PATIENTS/MATERIAL AND METHODS:The ANal CAncer study comprises a cohort of patients diagnosed with anal cancer in Sweden between 2011 and 2013 (n = 388). Participants filled out a study-specific questionnaire 3 and/or 6 years after diagnosis (n = 205). In this sub-study, only patients treated with curative intent were included. The association between perception of cure and QoL was analysed using logistic regression. Descriptive analyses were performed regarding secondary aims. RESULTS:A high proportion (80%) of the patients were either moderately or very sure of cure across all tumour stages, in both early and advanced tumour stages, and with no obvious improvement over time. Despite this 42% experienced fear of recurrence 6 years after diagnosis. A strong perception of cure was correlated with high QoL. INTERPRETATION:Even though most patients had a perception of being cured, several patients irrespective of tumour stage, felt unsure of cure and feared recurrence years after successful treatment. A strong perception of cure was also shown to be associated with a high QoL. We suggest that improved counselling could enhance the patient's perception of cure and to possibly improve QoL.

After cancer surgery it is common for patients to experience fatigue and evidence suggest physical activity habilitation can alleviate this. PHYSSURG C was a multicentre, controlled, randomized trial. Patients diagnosed with colorectal cancer were randomized to additional unsupervised moderate physical exercise in or usual care two weeks before and four weeks after surgery. Trial specific questionnaires were used at baseline, four weeks and 12 months. Outcomes were self-reported fatigue as well as quality of life, pain and mental recovery at the postoperative follow-ups. The aim was to investigate self-reported fatigue by RAND-36 at 4 week and 12 months after surgery in colorectal cancer patients undergoing a pre- and postoperative exercise intervention compared to standard care in a randomized trial. 518 patients were included in this analysis. At four weeks there was a difference in fatigue (mean difference 3.75 (CI 0.01,7.49), p=0.049) with intention to treat approach, and at both four weeks and 12 months there were differences in a per protocol analysis (mean difference 4.04 (CI 0.14,7.93), p=0.04) and (mean difference 4.29 (CI 0.44, 8.14) p=0.03) respectively. There were no differences between the intervention and control groups regarding quality of life, pain and mental recovery. The group who performed unsupervised exercise before and after surgery experienced reduced fatigue following surgery for colorectal cancer.

Laparoscopic lavage is an effective, safe, and feasible treatment in patients with perforated diverticulitis with purulent peritonitis. Laparoscopic lavage was introduced without any detailed knowledge regarding the mechanisms of action. The aim of this study was to validate the reproducibility of an animal model of purulent peritonitis and to study the effect of laparoscopic lavage on inflammatory proteins in this model. Forty rats, divided into eight groups (n = 5) were operated. Six groups underwent cecal ligation and puncture (CLP) causing peritonitis and two groups underwent sham surgery. Three CLP and one sham group received laparoscopic lavage, while the remaining groups acted as time-matched controls. Samples of abdominal fluid and blood were collected after 1, 2 or 3 h and analyzed regarding 92 inflammatory proteins using Olink Target 96 Mouse exploratory panel. Animals with peritonitis had higher levels of inflammatory proteins such as CCL3, IL17A and IL6 in abdominal fluid and serum compared to sham. The groups treated with laparoscopic lavage had lower levels of inflammatory proteins in both abdominal fluid and serum compared with untreated peritonitis groups, results were most distinct sampled after one hour. Our animal model is reproducible, and mimics perforated diverticulitis with purulent peritonitis with increased levels of inflammatory proteins in abdominal fluid and serum. The levels of several inflammatory proteins were lower following laparoscopic lavage treatment perhaps indicating the physiological effect of laparoscopic lavage. This model can be used to further explore the mechanisms involved in peritonitis and laparoscopic lavage treatment.

As the management of patients with local recurrence of rectal cancer has evolved over time, the aim of this study was to describe diagnosis, treatment and outcome of local recurrence in a recent national unselected two-year cohort. All patients registered with a diagnosis of rectal cancer in 2016 and 2017 who underwent abdominal resection of the rectal tumour were identified in the SCRCR. Medical charts were reviewed, identifying all patients diagnosed with local recurrence until end of follow-up June 30th, 2022. Of a total of 2828 included patients, 166 (5.9%) were diagnosed with local recurrence during the follow-up period. The median time to diagnosis of local recurrence was 19 months (range 1-69). Ninety-seven patients (58%) were diagnosed at scheduled follow-up. The most common anatomical site of local recurrence was the anastomosis/rectal stump (25%), followed by lateral recurrence (19%). Concurrent metastatic disease was seen in 90 patients (54%). Fifty-nine patients (36%) were considered for curative treatment. The tumour recurrence was resected in 54 patients (33%), which included pelvic exenteration surgery in 17 cases (31%). Microscopical radicality was achieved in 38 of resected patients (70%). At end of follow-up, only 29 patients (18%) were considered tumour free. The prognosis for patients with local recurrence is still poor. Considering that a large proportion of patients were diagnosed outside of scheduled follow-up, this may be insufficient to detect local recurrence. Whether more patients would be cured if diagnosed earlier is, however, unknown.

The primary aim of this study was to investigate whether rectus abdominis muscle atrophy is associated with a lower risk of developing parastomal hernia. Secondary objectives were to assess whether the use of prophylactic mesh is a risk factor for rectus abdominis muscle atrophy and whether the position of the stoma within the rectus abdominis muscle affects the risk of parastomal hernia. This retrospective study analysed patients from a prospective, randomised, multicentre trial in which rectal cancer patients were randomised to stoma creation with or without prophylactic mesh. Computed tomography at 12 months was evaluated to identify parastomal hernia, rectus abdominis muscle atrophy and position of stoma in the rectus abdominis muscle. Out of 149 patients, rectus abdominis muscle atrophy was observed in 9