Publications
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Kjæstad, Erik; Thiis-Evensen, Espen; Sveen, Anita; Bakka, Arne Olav & Schultz, Johannes Kurt
(2026).
Small Bowel Cancer: Implications of Preoperative Work-Up on Surgical Strategy.
World Journal of Surgery.
ISSN 0364-2313.
p. 1–12.
doi:
10.1002/wjs.70547.
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Kjæstad, Erik; Thiis-Evensen, Espen; Edwin, Bjørn von Gohren; Bakka, Arne Olav; Lilleaas, Anne Helene & Thorsen, Yngve
[Show all 7 contributors for this article]
(2026).
Extended D3 Mesenterectomy in Small Bowel Cancer Treatment: Feasibility and Importance for Staging. First Results of a Prospective Clinical Trial.
World Journal of Surgery.
ISSN 0364-2313.
p. 1–12.
doi:
10.1002/wjs.70550.
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Holte, Silje Stensholt; Avaliani, Natalia; Hoff, Geir Svein; Kazaryan, Airazat M.; Jaioun, Keson & Lauzikas, Giedrius
[Show all 7 contributors for this article]
(2025).
Effect of psyllium husk on low anterior resection syndrome after rectal cancer surgery—a pilot prospective cohort study.
Frontiers in Surgery.
12.
doi:
10.3389/fsurg.2025.1686486.
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Introduction Low anterior resection syndrome (LARS) is a frequent, undesired consequence of rectal cancer surgery. Psyllium husk has been suggested as a nutritional supplement in the management of LARS, but without trial-based evidence of its effect. In preparation of a randomized clinical trial, this pilot study aimed to estimate the effect of Psyllium husk in patients with LARS, determining the treatment duration required to observe the effect and assess patient compliance.
Methods This single arm phase II study included patients with LARS score >20 ten months or more after rectal resection. Patients who consented to participate were given 3.66 g Psyllium husk fiber twice daily for 56 days. The primary endpoint was severity of bowel dysfunction using the LARS score. The secondary endpoint was quality of life (QoL) using EQ-VAS score in the EQ-5D-5L questionnaire. A reduction of 7 points in LARS score was considered clinically relevant. Questionnaires and scores were collected on paper day 0 (baseline), day 28 and day 56.
Results 22 patients were assigned to the intervention and included in the analysis. The average age was 65.3 (SD 10.4), the average LARS score at baseline was 35,7 (SD 3.5), four patients had received radiotherapy. The proportion of patients with a LARS score reduction of 7 points or more compared to baseline was 50.0% at day 28 (11/22) and 50.0% at day 56 (10/20). The mean reduction in LARS scores from baseline to 8 weeks of treatment was 7.7 points. At day 28, the proportion of patients with a QoL score (EQ-VAS score) increase of 10 points or more was 36.4% (8/22), increasing to 60.0% (12/20) by day 56. Two patients dropped out after 4 weeks of treatment, one due to taste and consistency of the supplement and one due to inconsistently beneficial effect.
Conclusions Psyllium husk appears to clinically significantly improve both bowel dysfunction and QoL in rectal cancer patients suffering from LARS. This study highlights the need for further systematic research, and provides a strong basis for a well-designed RCT.
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Schultz, Johannes Kurt; Nikberg, Maziar; Chabok, Abbas; Thorisson, Arnar; Sigurdardottir, Johanna & Buchwald, Pamela
[Show all 8 contributors for this article]
(2025).
Changing paradigms in the management of complicated diverticulitis.
Scandinavian Journal of Surgery.
ISSN 1457-4969.
114(3),
p. 381–389.
doi:
10.1177/14574969251343452.
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Complicated colonic diverticulitis remains a frequent cause of hospital admissions in Western countries, associated with significant morbidity and health care utilization. Complications include abscess formation, perforation, sepsis, fistulas, and colonic stenosis, which may be present at initial presentation or develop during the disease course. Approximately 10%–20% of hospitalized diverticulitis cases are classified as complicated. Over recent decades, the management of this condition has undergone a paradigm shift—from routine surgical intervention to more individualized, evidence-based strategies emphasizing conservative treatment where appropriate. This review provides a comprehensive, clinically oriented summary of current diagnostic approaches, including the role of cross-sectional imaging, as well as non-operative and operative treatment options. It also outlines recommendations for follow-up, including indications for colonoscopy, and discusses ongoing controversies and future directions in the management of complicated diverticulitis.
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Malik, Yasir Gulzar; Benth, Jurate Saltyte; Hamre, Hanne Mari; Færden, Arne Engebreth & Schultz, Johannes Kurt
(2024).
Effect of radiotherapy on long-term quality of life in recurrence-free rectal cancer survivors (LaTE study): Nationwide inverse probability of treatment-weighted registry-based cohort study and survey.
BJS Open.
8(5).
doi:
10.1093/bjsopen/zrae091.
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Background Radiotherapy reduces local recurrence in locally advanced rectal cancer, but may cause harm in patients who do not experience recurrence. The aim was to investigate the impact of radiotherapy on long-term quality of life after curative treatment for rectal cancer, i.e. in patients without a recurrence during the follow-up. Methods All patients operated on for rectal cancer in Norway under 75 years of age between 30 September 2007 and 1 October 2020 were identified using the Cancer Registry of Norway. Exclusion criteria were distant metastasis, recurrence and dementia. The primary outcome measure was the Gastrointestinal Quality of Life Index. Secondary outcome measures included the 36-item Short Form Survey. Inverse probability weights based on a multiple logistic regression model were used to balance prechosen covariates between the radiotherapy and no radiotherapy groups when assessing differences in outcomes. Results Of 5014 invited patients, 2142 (43%) eligible patients answered the questionnaires. Of these 762 (36%) were treated with neoadjuvant radiotherapy plus surgery and 1380 (64%) with surgery alone. The mean follow-up time was 6.4 and 7.4 years respectively. After propensity score matching, the Gastrointestinal Quality of Life Index differed significantly between irradiated and non-irradiated patients ((mean(s.d.), mean score 103.8(19.4) versus 110.8(19.6) respectively, mean difference: −6.96 (95% c.i. −8.72 to −5.19); P < 0.001). Among patients without a stoma the mean difference was −8.1 points, whereas it was −5.7 for patients with a stoma. The radiotherapy group also scored significantly lower in 7 of 8 36-item Short Form Survey domains compared with the surgery alone group. Conclusion Long-term quality of life was significantly lower in patients without a recurrence during the follow-up who received radiotherapy compared with patients who did not. These findings warrant a critical re-evaluation of the use of radiotherapy both in traditional neoadjuvant treatment and in modern organ-preserving treatment regimens.
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Greijdanus, Nynke G.; Wienholts, Kiedo; Ubels, Sander; Talboom, Kevin; Hannink, Gerjon & Wolthuis, Albert
[Show all 725 contributors for this article]
(2023).
Stoma-free survival after anastomotic leak following rectal cancer resection: worldwide cohort of 2470 patients.
British Journal of Surgery.
ISSN 0007-1323.
110(12),
p. 1863–1876.
doi:
10.1093/bjs/znad311.
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Background: The optimal treatment of anastomotic leak after rectal cancer resection is unclear. This worldwide cohort study aimed to provide an overview of four treatment strategies applied.
Methods: Patients from 216 centres and 45 countries with anastomotic leak after rectal cancer resection between 2014 and 2018 were included. Treatment was categorized as salvage surgery, faecal diversion with passive or active (vacuum) drainage, and no primary/secondary faecal diversion. The primary outcome was 1-year stoma-free survival. In addition, passive and active drainage were compared using propensity score matching (2 : 1).
Results: Of 2470 evaluable patients, 388 (16.0 per cent) underwent salvage surgery, 1524 (62.0 per cent) passive drainage, 278 (11.0 per cent) active drainage, and 280 (11.0 per cent) had no faecal diversion. One-year stoma-free survival rates were 13.7, 48.3, 48.2, and 65.4 per cent respectively. Propensity score matching resulted in 556 patients with passive and 278 with active drainage. There was no statistically significant difference between these groups in 1-year stoma-free survival (OR 0.95, 95 per cent c.i. 0.66 to 1.33), with a risk difference of -1.1 (95 per cent c.i. -9.0 to 7.0) per cent. After active drainage, more patients required secondary salvage surgery (OR 2.32, 1.49 to 3.59), prolonged hospital admission (an additional 6 (95 per cent c.i. 2 to 10) days), and ICU admission (OR 1.41, 1.02 to 1.94). Mean duration of leak healing did not differ significantly (an additional 12 (-28 to 52) days).
Conclusion: Primary salvage surgery or omission of faecal diversion likely correspond to the most severe and least severe leaks respectively. In patients with diverted leaks, stoma-free survival did not differ statistically between passive and active drainage, although the increased risk of secondary salvage surgery and ICU admission suggests residual confounding.
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Malik, Yasir Gulzar; Benth, Jurate Saltyte; Hamre, Hanne Mari; Færden, Arne Engebreth; Ignjatovic, Dejan & Schultz, Johannes Kurt
(2023).
Chemotherapy reduces long-term quality of life in recurrence-free colon cancer survivors (LaTE study)—a nationwide inverse probability of treatment-weighted registry-based cohort study and survey.
Colorectal Disease.
ISSN 1462-8910.
doi:
10.1111/codi.16807.
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Abstract Aim Stage III colon cancer is routinely treated with adjuvant chemotherapy, which causes significant short‐term morbidity. Its effect on long‐term quality of life (QoL) is poorly investigated. The aim of this study was to investigate long‐term QoL after curative treatment for colon cancer and explore the impact of chemotherapy on general and disease‐specific QoL. Method All patients aged under 75 years operated on for colon cancer between 30 September 2007 and 1 October 2019 were identified by the Cancer Registry of Norway. Exclusion criteria were distant metastasis, recurrence, dementia and rectal/rectosigmoid cancer operation. The primary outcome measure was Gastrointestinal Quality of Life Index (GIQLI). Secondary outcome measures included the Short Form Health Survey (SF‐36). To achieve balanced groups when assessing differences in outcome measures the analyses were weighted by inverse probability weights based on a multiple logistic regression model with prechosen confounders. Results A total of 8627 patients were invited and 3109 responded (36% response rate). After exclusions 3025 patients were included, of whom 1148 (38%) had received adjuvant chemotherapy and 1877 (62%) had surgery alone, with mean follow‐up of 75.5 versus 74.5 months, respectively. The GIQLI differed significantly between the groups [mean 111.0 (SD 18.4) vs. 115.6 (SD 17.8), respectively; mean difference: −4.6 (95% CI −5.9; −3.2); p < 0.001]. Those with the highest neurotoxicity exhibited the lowest GIQLI. The adjuvant chemotherapy group scored significantly lower in six of eight SF‐36 domains compared with the surgery alone group. The main differences were found in social, physical and emotional function. Conclusion Long‐term QoL was significantly lower in patients who received adjuvant chemotherapy than in patients who did not. Neurotoxicity was closely related to reduced QoL in these patients. The low response rate limits the generalizability of the results.
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Kachapila, Mwayi; Monahan, Mark; Ademuyiwa, Adesoji O.; Adinoyi, Yakubu Momohsani; Biccard, Bruce M. & George, Christina
[Show all 1,785 contributors for this article]
(2023).
Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries.
BJA Open.
7.
doi:
10.1016/j.bjao.2023.100207.
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Background This study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($). Results High FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was $216 compared with $222 for low FiO2 leading to a −$6 (95% confidence interval [CI]: −$13 to −$1) difference in costs. In India, the average cost for high FiO2 was $184 compared with $195 for low FiO2 leading to a −$11 (95% CI: −$15 to −$6) difference in costs. In South Africa, the average cost for high FiO2 was $1164 compared with $1257 for low FiO2 leading to a −$93 (95% CI: −$132 to −$65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs. Conclusion High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this.
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Azhar, Najia; Lambrichts, Daniël; Lange, Johan; Yakub, Sheraz; Øresland, Tom & Schultz, Johannes Kurt
[Show all 8 contributors for this article]
(2023).
Laparoscopic lavage for Hinchey III perforated diverticulitis: factors for treatment failure in two randomized clinical trials.
British Journal of Surgery.
ISSN 0007-1323.
110(7),
p. 846–851.
doi:
10.1093/bjs/znad114.
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Abstract Background The Scandinavian Diverticulitis (SCANDIV) trial and the LOLA arm of the LADIES trial randomized patients with Hinchey III perforated diverticulitis to laparoscopic peritoneal lavage or sigmoid resection. The aim of this analysis was to identify risk factors for treatment failure in patients with Hinchey III perforated diverticulitis. Methods This was a post hoc analysis of the SCANDIV trial and LOLA arm. Treatment failure was defined as morbidity requiring general anaesthesia (Clavien–Dindo grade IIIb or higher) within 90 days. Age, sex, BMI, ASA fitness grade, smoking status, previous episodes of diverticulitis, previous abdominal surgery, time to surgery, and surgical competence were all tested in univariable and multivariable logistic regression analyses using an interaction variable. Results The pooled analysis included 222 patients randomized to laparoscopic lavage and primary resection (116 and 106 patients respectively). Univariable analysis found ASA grade to be associated with advanced morbidity in both groups, and the following factors in the laparoscopic lavage group: smoking, corticosteroid use, and BMI. Significant factors for laparoscopic lavage morbidity in multivariable analysis were smoking (OR 7.05, 95 per cent c.i. 2.07 to 23.98; P = 0.002) and corticosteroid use (OR 6.02, 1.54 to 23.51; P = 0.010). Conclusion Active smoking status and corticosteroid use were risk factors for laparoscopic lavage treatment failure (advanced morbidity) in patients with perforated diverticulitis.
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Sahli, Hannah; Azhar, Najia; Lydrup, Marie-Louise; Jörgren, Fredrik; Schultz, Johannes Kurt & Buchwald, Pamela
(2022).
Risk factors for recurrence and complications in acute uncomplicated diverticulitis: A retrospective cohort study.
International Journal of Surgery Open.
43.
doi:
10.1016/j.ijso.2022.100471.
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Reuter, Anna; Rogge, Lisa; Monahan, Mark; Kachapila, Mwayi; Morton, Dion G & Davies, Justine I
[Show all 50 contributors for this article]
(2022).
Global economic burden of unmet surgical need for appendicitis.
British Journal of Surgery.
ISSN 0007-1323.
109(10),
p. 995–1003.
doi:
10.1093/bjs/znac195.
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Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was USD 92 492 million using approach 1 and USD 73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was USD 95 004 million using approach 1 and USD 75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially.
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Toresen, Åsmund Lokdam; Johanssen, Anette; Ansari, Omar Ben Afzal; Holmedal, Stein Harald & Schultz, Johannes Kurt
(2021).
Conservative treatment of perforated diverticulitis: following the latest guidelines pays dividends.
The Lancet.
ISSN 0140-6736.
doi:
10.1016/S0140-6736(21)02003-1.
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Kleive, Dyre; Aas, Eline; Angelsen, Jon-Helge; Bringeland, Erling Audun; Nesbakken, Arild & Nymo, Linn Såve
[Show all 9 contributors for this article]
(2021).
Simultaneous Resection of Primary Colorectal Cancer and Synchronous Liver Metastases: Contemporary Practice, Evidence and Knowledge Gaps.
Oncology and Therapy.
ISSN 2366-1070.
9(1),
p. 111–120.
doi:
10.1007/s40487-021-00148-2.
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The timing of surgical resection of synchronous liver metastases from colorectal cancer has been debated for decades. Several strategies have been proposed, but high-level evidence remains scarce. Simultaneous resection of the primary tumour and liver metastases has been described in numerous retrospective audits and meta-analyses. The potential benefits of simultaneous resections are the eradication of the tumour burden in one procedure, overall shorter procedure time, reduced hospital stay with the likely benefits on quality of life and an expected reduction in the use of health care services compared to staged procedures. However, concerns about accumulating complications and oncological outcomes remain and the optimal selection criteria for whom simultaneous resections are beneficial remains undetermined. Based on the current level of evidence, simultaneous resection should be restricted to patients with a limited liver tumour burden. More high-level evidence studies are needed to evaluate the quality of life, complication burden, oncological outcomes, as well as overall health care implications for simultaneous resections.
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Azhar, Najia; Buchwald, Pamela & Schultz, Johannes Kurt
(2021).
Long-term Outcomes of Laparoscopic Lavage for Perforated Diverticulitis Remain Unfavorable-Reply.
JAMA Surgery.
ISSN 2168-6254.
156(11),
p. 1071–1071.
doi:
10.1001/jamasurg.2021.3306.
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Chabok, A.; Thorisson, A.; Nikberg, M.; Schultz, J.K. & Sallinen, Ville J.
(2021).
Changing Paradigms in the Management of Acute Uncomplicated Diverticulitis.
Scandinavian Journal of Surgery.
ISSN 1457-4969.
110(2),
p. 180–186.
doi:
10.1177/14574969211011032.
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Drake, Thomas M.; Pata, Francesco; Ghosh, Dhruv; Ademuyiwa, Adesoji O; Arnaud, Alexis P & Bhangu, Aneel
[Show all 56 contributors for this article]
(2020).
Surgical site infection after gastrointestinal surgery in children: an international, multicentre, prospective cohort study.
BMJ Global Health.
doi:
10.1136/bmjgh-2020-003429.
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Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings.
Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI).
Results Of 1159 children across 181 hospitals in 51 countries, 523 (45·1%) children were from high HDI, 397 (34·2%) from middle HDI and 239 (20·6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12·8% (51/397) in middle HDI and 24·7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI.
Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.
https://creativecommons.org/licenses/by/4.0/
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
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Azhar, Najia; Buchwald, Pamela; Ansari, Hamza; Schyman, Tommy; Yaqub, Sheraz & Øresland, Tom
[Show all 7 contributors for this article]
(2020).
Risk of colorectal cancer following CT-verified acute diverticulitis: a nationwide population-based cohort study.
Colorectal Disease.
ISSN 1462-8910.
p. 1406–1414.
doi:
10.1111/codi.15073.
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Aim Routine colonoscopy to exclude colorectal cancer (CRC) after CT‐verified acute diverticulitis is controversial. This study aimed to compare the incidence of CRC in patients with acute diverticulitis with that in the general population. Method Patients with an emergency admission for diverticular disease to any Norwegian hospital between 1 January 2008 and 31 December 2010 were included through identification in the Norwegian Patient Registry using International Classification of Diseases (ICD‐10) codes K57.1‐9. To estimate the age‐specific distribution of CT‐verified acute uncomplicated diverticulitis (AUD) and acute complicated diverticulitis (ACD) in this nationwide study population, numbers from the largest Norwegian emergency hospital were used. Patients diagnosed with CRC within 1 year following their admission for acute diverticulitis were detected through cross‐matching with the Cancer Registry of Norway. Based on both Norwegian age‐specific incidence of CRC and estimated age‐specific distribution of CT‐verified diverticulitis, standard morbidity ratios (SMRs) were calculated. Results A total of 7473 patients with emergency admissions for diverticular disease were identified (estimated CT‐verified AUD n = 3523, ACD n = 1206); of these 155 patients were diagnosed with CRC within 1 year. Eighty had a CT‐verified diverticulitis at index admission [41 AUD (51.3%); 39 ACD (49.7%)]. Compared with the general population, the SMR was 6.6 following CT‐verified AUD and 16.3 following ACD, respectively. Conclusion In the first year after CT‐verified acute diverticulitis, especially after ACD, the risk of CRC is higher than in the general population. This probably represents misdiagnosis of CRC as acute diverticulitis. Follow‐up colonoscopy should be recommended to all patients admitted with acute diverticulitis.
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Malik, Yasir Gulzar; Lyckander, Lars Gustav; Lindstrøm, Jonas Christoffer; Holmquist, Olof Dan Sebastian; Sheikh, Ariba Ehsan & Schultz, Johannes Kurt
[Show all 7 contributors for this article]
(2020).
Stratification of Stage III colon cancer may identify a patient group not requiring adjuvant chemotherapy.
Journal of Cancer Research and Clinical Oncology.
ISSN 0171-5216.
p. 1–11.
doi:
10.1007/s00432-020-03381-w.
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Abstract Purpose Adjuvant chemotherapy for colon cancer with lymph node involvement (Stage III) has been the standard of care since the 1990s. Meanwhile, considerable evolvement of surgery combined with dedicated histopathological examinations may have led to stage migration. Furthermore, prognostic factors other than lymph node involvement have proven to affect overall survival. Thus, adjuvant chemotherapy in Stage III colon cancer should be reconsidered. The objective was to compare recurrence rates and survival in stage III colon cancer patients treated with or without adjuvant chemotherapy. Further, to assess the impact of extensive mesenterectomy, lymph node stage and vascular invasion on outcome. Methods Consecutive patients operated for Stage III colon carcinoma between 31 December 2005 and 31 December 2015 were identified in the pathological code register by matching colon (T67) and either adenocarcinoma (M81403) or mucinous adenocarcinoma (M84803), with lymph node (T08) and metastasis of adenocarcinoma (M81406 or M84806). Medical records of all identified patients were reviewed. Results Of 216 identified patients, 69 received no postoperative adjuvant chemotherapy (group NC), 69 insufficient adjuvant chemotherapy (FLV or < minimum recommended 6 cycles FLOX, group IC), and 78 sufficient adjuvant chemotherapy (≥ 6 cycles FLOX, group SC). When adjusted for age and comorbidity, 5-year overall survival did not differ statistically significant between groups (76% vs. 83% vs. 85%, respectively). Vascular invasion and a high lymph node ratio significantly reduced overall survival. Conclusion The findings imply that subgroups of Stage III colon cancer patients have good prognosis also without adjuvant chemotherapy. For definite conclusions about necessity of adjuvant chemotherapy, prospective trials are needed.
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Thomas, Hannah S.; Weiser, Thomas G.; Drake, Thomas M.; Knight, Stephen R.; Fairfield, Cameron & Ademuyiwa, Adesoji O.
[Show all 50 contributors for this article]
(2019).
Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy.
British Journal of Surgery.
ISSN 0007-1323.
106(2),
p. 103–112.
doi:
10.1002/bjs.11051.
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Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89·6 per cent) compared with that in countries with a middle (753 of 1242, 60·6 per cent; odds ratio (OR) 0·17, 95 per cent c.i. 0·14 to 0·21, P < 0·001) or low (363 of 860, 42·2 per cent; OR 0·08, 0·07 to 0·10, P < 0·001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high‐HDI countries (risk difference −9·4 (95 per cent c.i. −11·9 to −6·9) per cent; P < 0·001), but the relationship was reversed in low‐HDI countries (+12·1 (+7·0 to +17·3) per cent; P < 0·001). In multivariable models, checklist use was associated with a lower 30‐day perioperative mortality (OR 0·60, 0·50 to 0·73; P < 0·001). The greatest absolute benefit was seen for emergency surgery in low‐ and middle‐HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low‐HDI countries was half that in high‐HDI countries.
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Glasbey, James C.; Adisa, Adewale O.; Costas-Chavarri, Ainhoa; Qureshi, Ahmad U.; Allen-Ingabire, Jean C. & Salem, Hosni Khairy
[Show all 50 contributors for this article]
(2019).
Global variation in anastomosis and end colostomy formation following left-sided colorectal resection.
BJS Open.
3,
p. 403–414.
doi:
10.1002/bjs5.50138.
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Background: End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods: This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results: In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion: Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone.
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Azhar, Najia; Kulstad, Hanna; Pålsson, Birger; Schultz, Johannes Kurt; Lydrup, Marie-Louise & Buchwald, Pamela
(2018).
Acute uncomplicated diverticulitis managed without antibiotics?difficult to introduce a new treatment protocol but few complications.
Scandinavian Journal of Gastroenterology.
ISSN 0036-5521.
doi:
10.1080/00365521.2018.1552987.
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Objective: Routine antibiotic treatment of acute uncomplicated diverticulitis (AUD) has been shown ineffective. In this study, the adherence to a new treatment protocol for uncomplicated diverticulitis was evaluated and the incidence of complications in patients treated with and without antibiotics was investigated. Materials and methods: A retrospective study of in-patients diagnosed with AUD at Helsingborg Hospital, Sweden between 01 January 2013 and 06 January 2015 was performed. Antibiotics were routinely administrated until 01 May 2014. Thereafter, a new antibiotic-free treatment protocol for uncomplicated diverticulitis was introduced. All the patients were followed regarding complications for minimum one year. Results: A total of 50 patients were studied after the new protocol implementation and, 60% (n = 31) of the patients were treated without antibiotics. Specialists initiated antibiotic therapy significantly more often than registrars (p=.03). More patients in the antibiotic group had comorbidities (p=.03), apart from that, no significant differences in baseline characteristics were noted between treatment groups. Patients treated with antibiotics after introduction of the new protocol had significantly higher C-reactive protein than patients managed without antibiotics (median 117 mg/L vs. 70, p=.005). The hospital stay was shorter in the non-antibiotic group (three days vs. two days; p=.008). No significant differences in complications were observed. Conclusions: Protocol compliance was lower than expected, indicating that implementation of new treatment regimens is challenging. This study confirms that complications are rare in AUD treated without antibiotics. However, the selection of the sickest patients to the treatment with antibiotics limits the interpretation of the results.
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Brochmann, Nina Dølvik; Schultz, Johannes Kurt; Jakobsen, Gunn Signe & Øresland, Tom
(2016).
Management of acute uncomplicated diverticulitis without antibiotics: a single-centre cohort study.
Colorectal Disease.
ISSN 1462-8910.
18(11),
p. 1101–1107.
doi:
10.1111/codi.13355.
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Schultz, Johannes Kurt; Yaqub, Sheraz; Wallon, Conny; Blecic, Liljana; Forsmo, Håvard Mjørud & Folkesson, Joakim
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(2015).
Laparoscopic lavage vs primary resection for acute perforated diverticulitis: The SCANDIV randomized clinical trial.
Journal of the American Medical Association (JAMA).
ISSN 0098-7484.
314(13),
p. 1364–1375.
doi:
10.1001/jama.2015.12076.
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IMPORTANCE Perforated colonic diverticulitis usually requires surgical resection, which is
associated with significant morbidity. Cohort studies have suggested that laparoscopic lavage
may treat perforated diverticulitis with less morbidity than resection procedures.
OBJECTIVE To compare the outcomes from laparoscopic lavage with those for colon
resection for perforated diverticulitis.
DESIGN, SETTING, AND PARTICIPANTS Multicenter, randomized clinical superiority trial recruiting
participants from 21 centers in Sweden and Norway from February 2010to June 2014. The last
patient follow-upwas in December 2014 and final review and verification of the medical records
was assessed in March 2015. Patients with suspected perforated diverticulitis, a clinical indication
for emergency surgery, and free air on an abdominal computed tomography scanwere eligible.
Of 509 patients screened, 415were eligible and 199were enrolled.
INTERVENTIONS Patients were assigned to undergo laparoscopic peritoneal lavage (n = 101)
or colon resection (n = 98) based on a computer-generated, center-stratified block
randomization. All patients with fecal peritonitis (15 patients in the laparoscopic peritoneal
lavage group vs 13 in the colon resection group) underwent colon resection. Patients with a
pathology requiring treatment beyond that necessary for perforated diverticulitis (12 in the
laparoscopic lavage group vs 13 in the colon resection group) were also excluded from the
protocol operations and treated as required for the pathology encountered.
MAIN OUTCOMES AND MEASURES The primary outcomewas severe postoperative
complications (Clavien-Dindo score >IIIa) within 90 days. Secondary outcomes included
other postoperative complications, reoperations, length of operating time, length of
postoperative hospital stay, and quality of life.
RESULTS The primary outcome was observed in 31 of 101 patients (30.7%) in the laparoscopic
lavage group and 25 of 96 patients (26.0%) in the colon resection group (difference, 4.7%
[95%CI, −7.9%to 17.0%]; P = .53). Mortality at 90 days did not significantly differ between
the laparoscopic lavage group (14 patients [13.9%]) and the colon resection group (11 patients
[11.5%]; difference, 2.4%[95%CI, −7.2%to 11.9%]; P = .67). The reoperation rate was
significantly higher in the laparoscopic lavage group (15 of 74 patients [20.3%]) than in the
colon resection group (4 of 70 patients [5.7%]; difference, 14.6%[95%CI, 3.5%to 25.6%];
P = .01) for patients who did not have fecal peritonitis. The length of operating time was
significantly shorter in the laparoscopic lavage group; whereas, length of postoperative
hospital stay and quality of life did not differ significantly between groups. Four sigmoid
carcinomas were missed with laparoscopic lavage.
CONCLUSIONS AND RELEVANCE Among patients with likely perforated diverticulitis and
undergoing emergency surgery, the use of laparoscopic lavage vs primary resection did not
reduce severe postoperative complications and led toworse outcomes in secondary end points.
These findings do not support laparoscopic lavage for treatment of perforated diverticulitis.
TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01047462
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Rutegård, Martin; Lindsköld, Marcus; Jörgren, Fredrik; Landerholm, Kalle; Matthiessen, Peter & Forsmo, Håvard Mjørud
[Show all 12 contributors for this article]
(2025).
SELective defunctioning Stoma Approach in low anterior resection for rectal cancer (SELSA): Protocol for a prospective study with a nested randomized clinical trial investigating stoma‐free survival without major LARS following total mesorectal excision.
doi:
10.1111/codi.70009.
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Saeed, Usman; Saunes, Therese Karina; Sjo, Ole Helmer & Schultz, Johannes Kurt
(2025).
Giant Colonic Diverticulum: Case report of a rare complication of a common disease.
International Journal of Surgery Case Reports (IJSCR).
127,
p. 1–6.
doi:
10.1016/j.ijscr.2025.110909.
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Introduction and importance: Giant Colonic Diverticulum (GCD) is a rare but potentially life-threatening
complication of diverticular disease, defined as a diverticulum larger than 4 cm, most commonly arising in
the sigmoid colon. Its rarity could lead to diagnostic delays and mismanagement.
Case presentation: A 64-year-old Caucasian female presented with persistent abdominal pain and abdominal
swelling. Examination revealed a palpable mass in the left flank. A computed tomography (CT) scan demonstrated an 11x10x14 cm air-filled cavity adjacent to the sigmoid colon, initially misdiagnosed as contained
perforated diverticulitis. Following a literature review, the diagnosis of GCD was considered. Definitive treatment involved a segmental sigmoid colectomy with en-bloc resection of the diverticulum. The postoperative
course was uneventful, and the patient was discharged on postoperative day four with complete symptom
resolution.
Clinical discussion: The presentation of GCD can mimic common complications of diverticular disease, making
diagnosis challenging. CT imaging is critical, typically showing a large air-filled cavity connected to the colon.
Surgical resection is the treatment of choice to prevent serious complications such as perforation, abscess,
volvulus, or malignancy. In this case, en-bloc resection proved effective, highlighting the importance of prompt
surgical management.
Conclusion: GCD is a rare and under-recognized clinical entity. Increased awareness is essential to ensure timely
diagnosis and treatment. This case underscores the importance of integrating imaging findings, clinical judgment, and surgical intervention for optimal outcomes and emphasizes the need for further case documentation to
aid in management strategies.
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Schultz, Johannes Kurt; Yaqub, Sheraz & Øresland, Tom
(2016).
Privacy policies of android diabetes apps and sharing of health information: In reply.
Journal of the American Medical Association (JAMA).
ISSN 0098-7484.
315(10),
p. 1053–1054.
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Published
May 30, 2022 2:48 PM
- Last modified
Nov. 13, 2025 5:25 PM
