Introduction: Standardisation has the potential to serve as a measure to mitigate complication rates. The objective was to assess the impact of standardisation by implementing a colorectal bundle (CB), which comprises nine elements, on the complication rates in left-sided colorectal resections. Patients and Methods: This prospective, multicentre, observational, cohort trial was conducted in Switzerland at nine participating hospitals. During the control period, each patient was treated in accordance with the local standard protocol at their respective hospital. In the CB period, all patients were treated in accordance with the CB. The primary endpoint was the Comprehensive Complication Index (CCI) at 30 days. Results: A total of 1141 patients were included (723 in the No CB group and 418 in the CB group). Median age was 66 years and 50.6% were female. Median CCI before and after CB implementation was 0.0 (Interquartile Range [IQR]: 0.0-20.9). A hurdle model approach was used for the analysis. The CB was not associated with the presence or severity of complications. Older age (Odds Ratio [OR] 1.02, 95% Confidence Intervall [CI]: 1.00-1.03), surgery for malignancy (OR 1.34, 95% CI: 1.01-1.92), emergency surgery (OR 2.19, 95% CI: 1.31-3.41), elevated nutritional risk score (OR 1.13, 95% CI: 1.01-1.24) and Body-Mass Index (OR 1.04, 95% CI: 1.00-1.06) were associated with higher odds of postoperative complications. In a supplementary per-protocol analysis, for each additional item of the CB fulfilled, the odds of anastomotic leakage (AL) were 24% lower (OR 0.76, 95% CI: 0.64-0.93). Conclusions: Dedicated teams can establish high quality colorectal services in a network of hospitals with a joint standard. The study can serve as a model for other healthcare settings to conduct and implement quality improvement programs. The consistent implementation of the CB items can reduce the occurrence of AL.

Background: Early-onset colorectal cancer (EOCC), defined as CRC in patients under 50, is rising alarmingly in Western countries. This study explores key differences in clinical profiles, socioeconomic factors, and oncological treatments between EOCC and later-onset colorectal cancer (LOCC) patients. Patients and methods: This multicenter cohort study analyzed CRC patients treated from January 2023 to June 2024 at 11 centers in Northwestern Switzerland. Patients with confirmed CRC were included, while exclusions applied to secondary CRC, unconfirmed cases, and those unable to consent. Statistical analyses included descriptive methods, Fisher’s exact test, Kruskal–Wallis tests, and logistic regression ( P ≤ 0.05). Results: Among 764 patients, 10.5% had EOCC and 89.5% LOCC. Mean age was 42.1 for EOCC and 70.8 for LOCC. EOCC patients were more often non-Swiss (67.5% vs. 32.2%, P < 0.001), faced greater financial hardship ( P < 0.001), consumed more glucose (>5 units/week) (48.8% vs. 35.2%, P = 0.02), and had more second-degree relatives with CRC ( P = 0.05). EOCC symptoms included abdominal pain (54.6%) and rectal bleeding (50.6%), while LOCC presented with rectal bleeding (35.4%) and bowel habit changes (25.3%). EOCC had longer diagnostic delays (7.2 vs. 4.2 months, P = 0.03) and reached a higher UICC stage (IIIC vs. IIIA). Adjuvant therapy was more frequent in EOCC for colon (52.4% vs. 35.2%, P = 0.04) and rectal cancer (58.3% vs. 33.3%, P = 0.02). Defunctioning ostomies were more common in EOCC (13.2% vs. 3.2%, P = 0.01). EOCC had shorter hospital stays (8.66 vs. 11.43 days, P = 0.05), but intensive care unit stays, complications, lymph node retrieval, and operation times were similar. Conclusion: These findings emphasize the need for tailored screening protocols and personalized management strategies to address the unique challenges faced by patients under 50 and to improve outcomes.

Purpose: Overall complication and leak rates in colorectal surgery showed only minor improvements over the last years and remain still high. While the introduction of the WHO Safer Surgery Checklist has shown a reduction of overall operative mortality and morbidity in general surgery, only minor attempts have been made to improve outcomes by standardizing perioperative processes in colorectal surgery. Nevertheless, a number of singular interventions have been found reducing postoperative complications in colorectal surgery. The aim of the present study is to combine nine of these measures to a catalogue called colorectal bundle (CB). This will help to standardize pre-, intra-, and post-operative processes and therefore eventually reduce complication rates after colorectal surgery. Methods: The study will be performed among nine contributing hospitals in the extended north-western part of Switzerland. In the 6-month lasting control period the patients will be treated according to the local standard of each contributing hospital. After a short implementation phase all patients will be treated according to the CB for another 6 months. Afterwards complication rates before and after the implementation of the CB will be compared. Discussion: The overall complication rate in colorectal surgery is still high. The fact that only little progress has been made in recent years underlines the relevance of the current project. It has been shown for other areas of surgery that standardization is an effective measure of reducing postoperative complication rates. We hypothesize that the combination of effective, individual components into the CB can reduce the complication rate. Trial registration: Registered in ClinicalTrials.gov on 11/03/2020; NCT04550156. Highlights: Purpose: Methods: Discussion: