Abstract Background Early onset colorectal cancer (EOCC), defined as colorectal cancer (CRC) ≤ 50 years, has seen an alarming rising incidence in western countries. Aims This research aims to determine the current state of incidence, symptoms, diagnostic methods, and treatment approach in EOCC compared to late onset CRC (LOCRC) in the extended Northwestern Switzerland. Methods Patients seeking care for CRC between April-November 2023 were enrolled in a prospective multicenter (11 hospitals within extended Northwestern Switzerland) observational cohort study. Information was collected using questionnaires and patient charts. Results We included 315 patients, thereof 38 (10.8%) EOCC. In total 211 (58.9%) patients were male, mean age was 42.5 and 71.2 years, respectively. Rectal bleeding was the main symptom in both groups (60.5% vs 37.0%), followed by change in bowel habits in EOCC and fatigue in LOCRC without reaching significance. Rectal bleeding and mucous, abdominal pain, change of bowel habits and bloating were significantly more often in EOCC. Significantly more LOCRC patients stated that their physical condition affected sexual erection and social interaction, whereas in EOCC, family life was significantly affected. For both groups, endoscopy was the leading diagnostic tool. EOCC had a diagnostic delay of 6.5 weeks compared to their counterparts. No difference in frequency of neoadjuvant treatment, surgical approach or need for emergency surgery was observed. In EOCC, a trend to more lymph node retrieval was observed and significantly more EOCC received an ostomy. Postoperatively, significantly more EOCC than LOCRC patients received adjuvant chemotherapy (55.6 % vs 28.6 %). Conclusion Our analysis illustrates the current standard-of-care of EOCC in the extended Northwestern Switzerland. EOCC compared to LOCRC patients present themselves differently to the medical community, leading to a different approach to their symptoms, which eventually results in a delayed diagnosis. Based on these results, it is time to foster awareness and start redefining national screening criteria.

Abstract Background Beneficial effects of centralization could be shown. During SARS-CoV2 pandemic however, the centralization in the UK healthcare system led to cessation of screening colonoscopies and oncological resections. In the decentralized healthcare system of Switzerland, a high frequency of colonoscopies could be maintained. Aims The aim of this international study is to evaluate if a decentralized health care systems can prevent the threatening unmet needs of colorectal cancer patients under pandemic conditions. Methods This observational trial was performed in the south-east of Scotland and in the extended northwest of Switzerland with a catchment area of 1.5 Mio. inhabitants each. Patients with colorectal cancer diagnosed during January 2019 and December 2022 were included. Results Six thousand six hundred and eighty patients were included in this preliminary analysis (4059 in the NHS group and 2621 in the Swiss group). In Scotland the median number of diagnosed patients per quarter was 258 pre-pandemics, 218 during lockdown and 258 after lockdown (p=0.56). There was no significant alteration of the median diagnosed patients per quarter during different phases in Switzerland (165 pre-pandemic vs. 187 during lockdown vs. 162 post-lockdown, p=0.56). In Scotland the median number of all performed tumor treatments per quarter were lower during lockdown (83 pre-pandemic vs. 75 during lockdown vs. 93 post-lockdown, p<0.01). In Switzerland the median treatment numbers per quarter didn´t differ during different phases (56 pre-pandemic vs. 62 during lockdown vs. 60 post-lockdown, p=0.51). The number of patients diagnosed with a T4 tumor during pandemic was higher in Scotland than in Switzerland (28% vs. 19%, p<0.01). The 30-day mortality under pandemic condition was 7.5% (65 of 859) in Scotland compared to 3.7% (14 of 374) in Switzerland (p=0.01). Conclusion SARS-CoV2 pandemic led to a reduction in performed cancer treatments in Scotland. In Switzerland's decentralized healthcare system, cancer treatments were maintained during pandemic.

Multimodal therapy has improved survival outcomes for rectal cancer (RC) significantly with an exemption for older patients. We sought to assess whether older non-comorbid patients receive substandard oncological treatment for localized RC referring to the National Comprehensive Cancer Network (NCCN) guidelines and whether it affects survival outcomes. This is a retrospective study using patient data from the National Cancer Data Base (NCDB) for histologically confirmed RC from 2002 to 2014. Non-comorbid patients between ≥50 and ≤85 years and defined treatment for localized RC were included and assigned to a younger (<75 years) and an older group (≥75 years). Treatment approaches and their impact on relative survival (RS) were analyzed using loess regression models and compared between both groups. Furthermore, mediation analysis was performed to measure the independent relative effect on age and other variables on RS. Data were assessed using the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) checklist. Of 59,769 included patients, 48,389 (81.0

Update: Management of colonic diverticulitis Abstract. Several classification systems exist for diverticulosis and diverticulitis. We preferably use the "Classification of Diverticular Disease" (CDD) to grade the severity of disease. This classification is based on imaging by CT scan or ultrasound. The CDD system divides patients into categories with a common therapeutic strategy. Acute uncomplicated diverticulitis is treated by oral or intravenous antibiotics. For the majority of patients with uncomplicated diverticulitis, antibiotic therapy might be omitted in favor of a solely symptomatic therapy. Acute diverticulitis complicated by a relevant abscess or a perforation is treated by interventional drainage or surgical therapy. Resection with primary anastomosis replaces more and more resection with end colostomy (Hartmann's procedure). For patients with sepsis, the concept of damage control surgery has been introduced. The indication for elective surgery after conservative treatment of diverticulitis shall be dictated by the degree of the patient's symptoms, rather than the number of conservatively treated episodes of diverticulitis. Persisting complications, as fistulas and stenosis, represent an indication for elective colonic resection.

Die Pravalenz und soziookonomischen Folgen der Stuhlinkontinenz werden unterschatzt. Eine entsprechende Awareness und ein aktives Screening sind essentiell.

Hämorrhoiden sind nicht per se behandlungsbedürftig. Trotz der zahlenmässigen und ökonomischen Relevanz ist das Krankheitsbild erstaunlich wenig erforscht, und die Behandlungsempfehlungen sind zurzeit wenig Evidenz-basiert.

Nachdem im ersten Teil dieses Artikels Ursachen und Diagnostik der Stuhlinkontinenz zur Sprache gekommen waren, behandelt der vorliegende Teil die aktuell empfohlenen konservativen und chirurgischen Therapiemöglichkeiten.

Les hémorroïdes n´ont pas besoin de traitement en soi. Malgré leur pertinence numérique et économique, le tableau clinique est étonnamment peu étudié et les recommandations de traitement sont basées sur peu de preuves.

La prevalence et les consequences socio-economiques de l’incontinence fecale sont sous-estimees. Une prise de conscience correspondante et un depistage actif sont essentiels.

Apres avoir aborde les causes et le diagnostic de l’incontinence fecale dans la premiere partie de cet article, cette partie est consacree aux options therapeutiques conservatrices et chirurgicales actuellement recommandees.

Tumor budding is a robust prognostic parameter in colorectal cancer and can be used as an additional factor to guide patient management. Although backed by large bodies of data, a standardized scoring method is essential for integrating tumor budding in reporting protocols. The International Tumor Budding Consensus Conference (ITBCC) 2016 has proposed such a scoring system. The aim of this study is to validate the ITBCC method of tumor budding assessment on a well-characterized colorectal cancer cohort. Three hundred seventy-nine patients with resected stage I-IV colorectal cancer were entered into the study. Tumor budding was scored by 2 pathologists according to the ITBCC recommendations on hematoxylin and eosin-stained slides and scored as BD1 (low grade), BD2 (intermediate grade), and BD3 (high grade). Analysis was performed using a 3-tier approach, a 2-tier approach (BD1 + 2 versus BD3) and budding as a continuous variable. High-grade tumor budding was associated with adverse clinicopathological features including higher pT, higher pN stage, and higher TNM stage (all P < .001) and poorer overall survival on univariate analysis (P = .0251 for BD1/2/3, P = .0106 for BD1 + 2 versus BD3, and P = .0195 for continuous scores; hazard ratio, 1.023 [95% confidence interval, 1.004-1.043 per bud]). In stage II cancers, BD3 was associated with poorer disease-free survival (P < .01). Tumor budding assessed by the method proposed by the ITBCC is applicable to colorectal cancer resection specimens and can be used for widespread reporting in routine.

In colorectal cancer, CDX2 expression is lost in approximately 20% of cases and associated with poor outcome. Here, we aim to validate the clinical impact of CDX2 and investigate the role of promoter methylation and histone deacetylation in CDX2 repression and restoration.