BACKGROUND
/Aims: Few studies have explored how family history of colorectal cancer (CRC) affects CRC incidence in inflammatory bowel disease (IBD). We estimated CRC incidence rates (IRs) and IR differences, by family history of CRC, and the interaction between IBD and family history.
METHODS
Nationwide, register-based cohort study 1996-2023, including patients with IBD and matched (age, sex, parish, year) comparators from the general population. The exposure was family history, defined as the number of first-degree relatives (parent, sibling, or child) and their age at CRC diagnosis (<50 or ≥50 years).
RESULTS
During a median follow-up of 11 years, 1,882 CRC events occurred in 124,387 patients with IBD (IR 1.17[95%CI:1.12-1.23]/1,000 person-years) and 14,177 CRC events in 1,213,641 comparators (IR 0.88[95%CI:0.86-0.89]/1,000 person-years). In IBD, the greatest CRC risk increase was seen in those with ≥2 affected relatives: 2.69(95%CI:0.60-4.78) additional cases per 1,000 person-years versus no family history, while risk increase with early-onset CRC heredity was modest: 0.42(95%CI: -0.47-1.31)/1,000 person-years. The IRs were comparable between patients and matched comparators with the same family history, except among those without family history of CRC, where the CRC incidence was higher in IBD. The relative effect of family history was weaker in IBD, where the baseline CRC risk was already elevated.
CONCLUSION
On the absolute scale, family history of CRC increased CRC incidence similarly in IBD and matched comparators, with the greatest increase in individuals with multiple affected relatives. Guidelines advise special attention to patients with family history of early-onset CRC; our findings raise the question if surveillance strategies should instead prioritize patients with multiple affected relatives.
Å. H. Everhov, Kári Kristjánsson, J. Ludvigsson et al.· Gastroenterology· 0 citations
Laparoscopic Hartmann's reversal is increasingly performed. Enhanced Recovery After Surgery (ERAS) protocols may improve postoperative recovery. However, evidence regarding whether male sex, delayed reversal and compliance to ERAS protocols influence the risk for anastomotic leakage (AL) remains limited.
This cohort study included consecutive patients undergoing Hartmann's reversal at a tertiary colorectal centre between July 2015 and June 2025. Prospectively registered ERAS data were complemented by retrospective chart review. The primary outcome was severe complications within 30 days, defined as AL according to ISREC criteria or complications graded Clavien–Dindo >IIIa. Associations between male sex, time to reversal, intention-to-treat minimally invasive surgery (MIS), ERAS compliance, and severe complications were assessed using logistic regression adjusted for age, Body Mass Index, and American Society of Anesthesiologisists classification.
One hundred seventy patients were included, of whom 94 (55 per cent) were male. The mean age was 60 years, and the mean interval to reversal was 18.5 months. One hundred forty-four patients were operated by MIS, 15 were converted and 11 by planned open surgery. Severe complications occurred in 17 and AL in 9 patients respectively. Male sex was associated with increased odds of severe complications (OR 3.21, 95% c.i. 1.03 to 10.02) while time to reversal and intention-to-treat MIS were not. Preoperative ERAS compliance was associated with reduced odds of severe complications (OR 0.93/point increase, P<0.05).
Hartmann's reversal showed low rates of severe complications and AL irrespective of reversal timing. Male sex may increase the risk of severe complications, whereas improved ERAS compliance appears protective.
Gabriella Söderman, C. Nordenvall, Jonas Nygren et al.· British Journal of Surgery· 0 citations
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