Diseases of the colon and rectum
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The population of Finland is aging fast, and dietary fiber consumption has decreased during the past few decades; the prevalence of sigmoid diverticular perforation can therefore be anticipated to increase. This study presents our experience concerning the outcome of 133 patients admitted to a university hospital for diverticular perforation during a 15-year period. ⋯ The prevalence of perforated sigmoid diverticulitis is increasing in northern Finland. Mannheim Peritonitis Index score can be used in predicting the outcome of patients admitted for perforated sigmoid diverticulitis.
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Preoperative chemoradiation therapy is used widely in the treatment of rectal cancer. The predictive value of response to neoadjuvant remains uncertain. We retrospectively evaluated the impact of response to preoperative and, specifically, of T-level downstaging, nodal downstaging, and complete pathologic response after chemoradiation therapy on oncologic outcome of patients with locally advanced rectal cancer. ⋯ T-level downstaging and complete pathologic response after preoperative chemoradiation therapy followed by definitive surgical resection for advanced rectal cancer resulted in decreased recurrence and improved disease-free survival. Advanced rectal cancers that undergo T-level downstaging and complete pathologic response after chemoradiation therapy may represent subgroups that are characterized by better biologic behavior.
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This study was designed to evaluate the long-term natural history of sigmoid diverticulitis in patients treated nonoperatively after a first acute episode and to assess the role of elective colectomy. ⋯ We propose that after a first acute episode of diverticulitis treated nonoperatively, elective colectomy should be offered to young patients (< or =50 years old) with severe diverticulitis on computed tomography.