SCANDIV Trial
Scandinavian Diverticulitis trial (ClinicalTrials.gov NCT01047462) — a pragmatic, open-label, multicenter RCT run in 21 hospitals across Sweden and Norway (enrolled Feb 2010-Jun 2014), comparing laparoscopic peritoneal lavage vs. primary sigmoid resection for acute perforated diverticulitis (Hinchey stage <IV at index surgery = purulent, not fecal, peritonitis). 199 patients randomized (101 lavage / 98 resection).
One of three major European RCTs on this question, alongside DILALA (headline results now summarized at the textbook/secondary level on Diverticulitis, per ASCRS Ch38 - Colonic Diverticular Disease — not yet independently ingested from its primary publications) and the Ladies trial (lavage arm — now ingested, see below).
Publications tracked here
| Report | Follow-up | Status in this wiki |
|---|---|---|
| Schultz et al., JAMA 2015 (314(13):1364-1375) — index trial results | 90-day | Not yet ingested |
| Schultz et al., Br J Surg 2017 (104(10):1382-1392) | 1-year | Not yet ingested |
| Azhar et al., JAMA Surg 2021 — Azhar 2021 - SCANDIV 5-Year Outcomes | 5-year | Ingested |
Headline result (5-year data)
No significant difference in severe complications, mortality, or QoL between lavage and resection. Lavage had a much lower long-term stoma rate (8% vs 33%) but significantly higher diverticulitis recurrence (21% vs 4%) and unplanned reoperation rate (26% vs 12%), with 30% of lavage patients eventually undergoing sigmoid resection anyway. See Azhar 2021 - SCANDIV 5-Year Outcomes for full detail and Diverticulitis for how this fits the broader treatment picture.
Cross-trial comparison: SCANDIV vs. Ladies trial
Both trials show the same recurrence signal (SCANDIV 21% vs 4%; Ladies 20% vs 2% — lavage vs. resection) but diverge on short-term morbidity: Ladies trial was stopped early after an interim analysis showed a stark reintervention signal in the lavage arm (18 vs 2 patients, p=.001) and significantly higher 30-day major morbidity (39% vs 19%, p=.043). SCANDIV's 5-year report found no significant difference in severe complications (29% vs 25%, p=.58). Whether this reflects different endpoint timing/definitions, different patient selection, or real heterogeneity in how Hinchey III was confirmed across trials is an open question — see Vennix 2015 - Ladies Trial LOLA for fuller discussion.
Open items
- Ingest the 90-day (Schultz 2015 JAMA) and 1-year (Schultz 2017 BJS) SCANDIV reports if available, to see how the recurrence/reoperation gap develops over time.
- Consider adding a dedicated DILALA trial page once its primary publications (Thornell et al., Kohl et al.) are independently ingested — referenced heavily in both SCANDIV's and Ladies trial's discussions, and now summarized at the textbook/secondary level on Diverticulitis (per ASCRS Ch38 - Colonic Diverticular Disease), but still not ingested from primary literature.