Colorectal Surgery Wiki

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Log

Append-only chronological record. Each entry starts with ## [YYYY-MM-DD] <type> | <title> so it stays greppable, e.g. grep "^## \[" wiki/log.md | tail -5.

[2026-08-18] setup | Wiki scaffold created

  • Created vault structure (raw/, wiki/sources, wiki/conditions, wiki/procedures, wiki/concepts, wiki/guidelines-trials), CLAUDE.md schema, and index/overview/log pages.
  • Ready for first source ingest.

[2026-08-18] ingest | Azhar 2021 - SCANDIV 5-Year Outcomes

  • Filed source page for the SCANDIV trial’s 5-year long-term follow-up (JAMA Surg 2021): laparoscopic lavage vs. primary resection for perforated purulent diverticulitis.
  • Created SCANDIV Trial (guidelines-trials) to track this landmark RCT across its publications (90-day/1-year reports not yet ingested).
  • Created Diverticulitis (first condition page) — Hinchey classification folded in per Stephen’s request, plus the lavage-vs-resection synthesis and diverging ASCRS/ESCP guideline positions.
  • Updated index.md and the sources/conditions/guidelines-trials landing pages.

[2026-08-18] ingest | Vennix 2015 - Ladies Trial LOLA

  • Filed source page for the Ladies trial (LOLA group), Lancet 2015 — lavage vs. sigmoidectomy for perforated purulent diverticulitis, stopped early for safety.
  • Created Ladies Trial (LOLA) guidelines-trials page.
  • Updated SCANDIV Trial with a cross-trial comparison section: recurrence signal replicates closely between SCANDIV and Ladies, but short-term morbidity/reintervention signal is starker in Ladies (trial-stopping) than in SCANDIV’s 5-year report — flagged as an open question.
  • Updated Diverticulitis with the same cross-trial synthesis, plus a note that Hinchey III/IV distinction is unreliable pre/intraoperatively in both trials.
  • Updated index.md and the sources/guidelines-trials landing pages.

[2026-08-18] ingest | Boublikova 2023 - TNT in Rectal Cancer Review

  • First rectal cancer / oncology source (prior sources were diverticulitis surgery). Filed as a narrative review synthesizing 4 phase III TNT trials (POLISH II, RAPIDO, PRODIGE 23, STELLAR).
  • Created Total Neoadjuvant Therapy (TNT) concept page — efficacy/trade-offs (incl. RAPIDO’s locoregional recurrence signal), risk-stratified indications, RT/chemo/immunotherapy regimens, sequencing, non-operative management, adjuvant therapy, and the review’s risk-based algorithm.
  • Created Rectal Cancer as a stub condition page (staging/anatomy/procedures not yet covered) to anchor future rectal cancer sources.
  • Updated index.md and the sources/conditions/concepts landing pages.

[2026-08-19] ingest | Hoehn 2021 - Appendiceal Neoplasms

  • Filed source page for this ASCO Educational Book review covering all 5 histopathologic subtypes of appendiceal neoplasms (MAN/PMP, NEN, GCA, colonic-type adenocarcinoma, signet ring adenocarcinoma).
  • Created Appendiceal Neoplasms condition page — AJCC 8th ed. + PSOGI staging, management by subtype, cross-cutting notes (right hemicolectomy indications, metastatic workup).
  • Created Cytoreductive Surgery and HIPEC concept page — PCI/CC scoring, appendiceal PMP outcomes, and the CRS/HIPEC controversies (PRODIGE 7, COLOPEC, PCI cutoff debate, agent choice).
  • Updated index.md and the sources/conditions/concepts landing pages.

[2026-08-19] ingest | Lambrichts 2019 - LADIES DIVA Trial

  • Filed source page for the LADIES trial’s DIVA arm: Hartmann’s procedure vs. primary anastomosis for Hinchey III/IV perforated diverticulitis. Primary anastomosis strongly favored (stoma-free survival 94.6% vs 71.7%, HR 2.79, p<0.0001) — one of the more decisive findings in the wiki so far, and the first source covering Hinchey IV (fecal peritonitis).
  • Expanded Ladies Trial (LOLA) into a unified Ladies Trial page covering both LOLA and DIVA arms (added aliases: ["Ladies Trial", "LADIES Trial"] to frontmatter so existing backlinks still resolve under the old filename).
  • Added a “Hartmann’s procedure vs. primary anastomosis” section to Diverticulitis.
  • Updated index.md, sources/guidelines-trials landing pages.

[2026-08-19] ingest | Sabiston Ch52 - Diverticular Disease, Obstruction & Pseudo-Obstruction

  • First chunk of the large (82-page) Sabiston “Colon and Rectum” textbook chapter, filed as a reference source (not primary literature) per Stephen’s instruction. Chapter is being split into topic chunks across multiple ingests (this one: diverticular disease completion, large bowel obstruction, Ogilvie syndrome; still to come: IBD, neoplasia/rectal cancer surgery, pelvic floor).
  • Expanded Diverticulitis — closed two previously flagged open items: uncomplicated diverticulitis management (antibiotics controversy, colonoscopy timing, recurrence) and elective surgery timing (shifted from “number of attacks” to individualized assessment). Added a special populations section (right-sided, immunocompromised, young patients — the last of which overturns older “operate after one attack under 50” teaching).
  • Created Large Bowel Obstruction and Colonic Pseudo-Obstruction (Ogilvie Syndrome) as new condition pages — general surgical topics within a colorectal surgeon’s scope, not previously covered.
  • Copied the full chapter PDF to raw/ as Sabiston Ch52 - Colon and Rectum.pdf; later chunks will cite specific page ranges within the same file.
  • Updated index.md, conditions/sources landing pages.

[2026-08-19] ingest | Sabiston Ch52 - Inflammatory Bowel Disease

  • Second chunk of the Sabiston “Colon and Rectum” chapter, filed as a reference source (not primary literature). Covers the full IBD section — the wiki’s first content on UC/Crohn’s.
  • Created Inflammatory Bowel Disease (shared epidemiology/classification/clinical features/ diagnosis/medical treatment), Ulcerative Colitis and Crohn Disease (disease-specific surgical indications and options) as three separate condition pages given the volume of surgeon-relevant detail.
  • Created Ileal Pouch-Anal Anastomosis (IPAA) — the wiki’s first procedure page — covering J-pouch construction, stapled vs. hand-sewn technique, tension-reducing maneuvers, complications, and functional outcomes. Referenced by both the UC and Crohn’s pages.
  • Flagged that none of this chunk’s content is backed by primary trial/cohort data yet — it’s a textbook skeleton (classification schemes, drug tables, indications-for-surgery framework) pending future primary-literature ingests (biologic trials, pouchitis outcomes, UC surveillance literature).
  • Updated index.md, conditions/procedures/sources landing pages (Procedures.md gets its first real entry).

[2026-08-19] ingest | Sabiston Ch52 - Infectious & Ischemic Colitis

  • Third chunk of the Sabiston “Colon and Rectum” chapter, filed as a reference source (not primary literature). Covers Infectious Colitis (C. difficile in depth, plus other enteric pathogens) and Ischemic Colitis.
  • Created Infectious Colitis — C. diff epidemiology/risk factors/severity scoring/diagnosis/ treatment ladder (vancomycin/fidaxomicin over metronidazole)/FMT/monoclonal antibodies/surgical indications, plus a table of other enteric pathogens (Campylobacter, Yersinia, Shigella, Salmonella, CMV). Corrected a source error (chapter’s table lists Campylobacter as gram-positive; it’s gram-negative) rather than propagating it.
  • Created Ischemic Colitis — watershed anatomy (Griffiths point, Sudeck’s point, right colon vulnerability), risk factors, diagnosis (endoscopy as gold standard, single-stripe sign, CT findings), treatment (conservative succeeds in ~80%), and surgical technique (ICG angiography for viability assessment, damage-control/second-look approach, no indication for revascularization unlike small-bowel mesenteric ischemia).
  • Updated index.md, conditions/sources landing pages.

[2026-08-19] ingest | Sabiston Ch52 - Colorectal Neoplasia & Colon Cancer Surgery

  • Fourth (and largest so far) chunk of the Sabiston “Colon and Rectum” chapter, filed as a reference source (not primary literature). Covers CRC molecular genetics, polyps, all five hereditary CRC syndromes, TNM staging, and colon cancer surgical technique/obstructing colon cancer — everything up to where “Rectal Cancer” begins in the chapter (next chunk).
  • Created Colorectal Cancer Molecular Pathways (chromosomal instability, CIMP, MSI mutator pathway, EMT, CMS1-4) and Colorectal Cancer Staging (TNM) as new concept pages.
  • Created Colorectal Polyps (nonneoplastic/serrated/neoplastic, Haggitt/Kikuchi classification, postpolypectomy surveillance) and Obstructing Colon Cancer as new condition pages.
  • Created Hereditary Colorectal Cancer Syndromes as an overview/comparison page, with three detail pages: Familial Adenomatous Polyposis (FAP) (including MUTYH-associated polyposis), Lynch Syndrome, and Hamartomatous Polyposis Syndromes (Peutz-Jeghers + juvenile polyposis). Flagged that the Lynch syndrome extended-vs-limited-colectomy question has no prospective RCT per the source itself — a good target for a future primary-literature ingest.
  • Created Colon Cancer Resection as a new procedure page — general oncologic principles plus technique by tumor location (right, transverse, splenic flexure, left).
  • Updated index.md, conditions/concepts/procedures/sources landing pages.

[2026-08-19] ingest | Sabiston Ch52 - Rectal Cancer Surgery

  • Fifth chunk of the Sabiston “Colon and Rectum” chapter, filed as a reference source (not primary literature). Covers rectal cancer preoperative evaluation/staging through TME history, LAR, sphincter-sparing surgery, taTME, APR, anastomotic complications, LARS, and adjuvant chemotherapy by stage. One chunk (pelvic floor disorders) remains in this chapter.
  • Substantially expanded the previously-stub Rectal Cancer page: preoperative evaluation, ERUS/MRI staging, the TME/CRM/downstaging history (German Rectal Cancer Study, Heald, Quirke, Habr-Gama watch-and-wait), survival by stage, surveillance schedule, and adjuvant chemotherapy by stage (including the IDEA duration-trial risk stratification and the metastatic-disease regimen-selection framework by RAS/BRAF status and tumor sidedness). This page now sits properly alongside the existing Total Neoadjuvant Therapy (TNT) concept page instead of being a TNT-only placeholder.
  • Created three new procedure pages: Local Excision of Rectal Neoplasms, Total Mesorectal Excision (TME) & Sphincter-Sparing Resection (LAR + coloanal anastomosis + taTME grouped together), and Abdominoperineal Resection (APR).
  • Created Colorectal Anastomotic Complications as a new concept page (leak, necrosis, bleeding, twisting, strictures — cross-cutting, not rectal-specific) and Low Anterior Resection Syndrome (LARS) as a new condition page.
  • Updated index.md, conditions/concepts/procedures/sources landing pages.

[2026-08-19] ingest | Sabiston Ch52 - Pelvic Floor Disorders & Constipation

  • Sixth and final chunk of the Sabiston “Colon and Rectum” chapter (Colon.pdf) — all 82 pages now ingested across 6 chunks, filed as reference sources (not primary literature) per Stephen’s original instruction. Covers anorectal physiology testing/imaging, rectal prolapse, solitary rectal ulcer syndrome, rectocele, and constipation.
  • Created Anorectal Physiology Testing as a new concept page — manometry, balloon expulsion, pudendal nerve terminal motor latency, EMG, endoanal ultrasound, defecography, colonic transit study — the shared diagnostic toolkit for all the pelvic floor condition pages below.
  • Created Rectal Prolapse (Procidentia) (condition) and Rectal Prolapse Repair (procedure, abdominal mesh rectopexy vs. perineal Altemeier/Delorme/STARR approaches, including the note that ASCRS guidelines do not recommend STARR given its complication profile).
  • Created Solitary Rectal Ulcer Syndrome (SRUS), Rectocele, and Constipation (Rome IV criteria, slow transit constipation, TAC-IRA/CIRA surgical options) as new condition pages.
  • Updated index.md, conditions/concepts/procedures/sources landing pages.
  • With this chunk complete, only the Sabiston “Small Bowel” chapter (61 pages) remains as the last planned source for this wiki’s initial ingest pass.

[2026-08-19] ingest | Sabiston Ch50 - Small Bowel Anatomy, Physiology, Obstruction & Crohn Disease

  • First chunk (of an expected 3) of the Sabiston “Small Bowel” chapter (Chapter 50, “Small Intestine,” authors Tong Gan & B. Mark Evers) — the final source in the original ingest list. Filed as a reference source (not primary literature), following the same discuss-first, chunked workflow used for the Colon and Rectum chapter, per Stephen’s blanket approval to proceed through the rest of this source without stopping to ask each time.
  • Created Small Intestine Anatomy & Physiology as a new concept page — embryology; gross, neurovascular/lymphatic, and microscopic anatomy; digestion/absorption physiology (carbs, protein, fat, water/electrolytes/vitamins); motility (MMC); endocrine function (GI hormones/ receptors); immune function (GALT, Peyer patches, IgA).
  • Created Small Bowel Obstruction as a new condition page, distinct from the existing Large Bowel Obstruction page — causes (adhesions ~60%, neoplasms, hernias, Crohn’s, misc), pathophysiology, simple vs. strangulating obstruction, diagnosis (imaging accuracy), treatment ladder, and management of specific problems (recurrent obstruction/adhesion prevention, acute postoperative obstruction, ileus as a differential).
  • Substantially expanded the existing Crohn Disease page (previously a colon-surgery-only stub from Sabiston Ch52 - Inflammatory Bowel Disease) with a full small-bowel-focused treatment: history, epidemiology, etiology (including the NOD2/CARD15 genetics table), gross/microscopic pathology, Montreal classification, clinical manifestations, diagnosis (serology, fecal markers, CTE/MRE, endoscopy including capsule endoscopy, CDAI), the complete medical therapy ladder, and small-bowel-specific surgical treatment (primary anastomosis vs. diversion, anastomotic technique including Kono-S, laparoscopic approach, and specific problems: acute ileitis, stricturing disease/ strictureplasty, bypass procedures, penetrating disease, perforation). Prior colonic-surgery content preserved and merged in rather than overwritten.
  • Updated index.md, conditions/concepts/sources landing pages.
  • Next: remaining Inflammatory and Infectious Diseases (typhoid, immunocompromised enteritis), Neoplasms, Diverticular Disease, and Miscellaneous Problems sections of this chapter (pages 31–61).

[2026-08-19] ingest | Sabiston Ch50 - Infectious Enteritis & Small Bowel Neoplasms

  • Second chunk of the Sabiston “Small Bowel” chapter, continuing without per-chunk approval pauses per Stephen’s instruction to proceed through the rest of this source using the established methods.
  • Merged the remainder of the Crohn Disease section into the existing Crohn Disease page: colorectal disease surgical principle, perianal disease (fistulotomy/setons/infliximab/diverting stoma/proctectomy), duodenal disease, GI bleeding, urologic complications, and a new Prognosis section including the postoperative surveillance algorithm (Fig. 50.25, risk-stratified anti-TNF/AZT-6MP vs. metronidazole with surveillance endoscopy).
  • Created Typhoid Enteritis and Enteritis in the Immunocompromised Host as new condition pages — the latter covering protozoal (Cryptosporidium, Isospora, Microsporidium), bacterial, mycobacterial (MAC, TB), viral (CMV), and fungal enteric pathogens in AIDS/transplant patients.
  • Created Small Bowel Neoplasms as a new overview condition page (epidemiology, risk factors, molecular genetics, clinical manifestations, diagnosis, benign tumors, and lymphoma), plus three dedicated pages for the largest malignant subtypes: Small Bowel Neuroendocrine Tumors (NETs) (carcinoid syndrome, CgA/5-HIAA/DOTATATE diagnosis, SSA/everolimus/PRRT treatment), Small Bowel Adenocarcinoma (surgical treatment by location, adjuvant chemotherapy, prognosis), and Gastrointestinal Stromal Tumors (GIST) (KIT/CD117, mitotic index risk stratification, imatinib-based treatment algorithm) — mirroring the multi-page split used for the colon cancer chunk of the Colon and Rectum chapter.
  • Updated index.md, conditions/sources landing pages.
  • Next: Diverticular Disease (duodenal, jejunal/ileal, Meckel) and Miscellaneous Problems (ulcerations, foreign bodies, fistulas, pneumatosis intestinalis, blind loop syndrome, radiation enteritis, short bowel syndrome, vascular compression of duodenum) — the final ~16 pages of this chapter.

[2026-08-19] ingest | Sabiston Ch50 - Diverticular Disease & Miscellaneous Problems

  • Third and final chunk of the Sabiston “Small Bowel” chapter (pages 46-61) — all 61 pages now ingested across 3 chunks, filed as reference sources per Stephen’s original instruction. This completes the wiki’s entire originally planned ingest list (5 primary-literature papers + both Sabiston textbook chapters).
  • Added GIST mutation-directed prognosis/therapy detail (D842V PDGFRα resistance, exon 9 dosing, dasatinib/regorafenib/nilotinib/sorafenib) to Gastrointestinal Stromal Tumors (GIST), and a Metastatic Neoplasms subsection (melanoma as the leading extraabdominal source) to Small Bowel Neoplasms.
  • Created Small Bowel Diverticular Disease as a new overview page (true vs. false diverticula), plus three detail pages: Duodenal Diverticula (intraluminal vs. extraluminal, biliary/ pancreatic complications, diverticulectomy technique), Jejunal and Ileal Diverticula, and Meckel Diverticulum (including the genuinely unresolved incidental-resection controversy — Soltero and Bill’s historical conservative recommendation vs. more recent malignancy-risk-driven arguments for resection).
  • Created seven new condition pages for the chapter’s Miscellaneous Problems section: Small Bowel Ulcerations, Ingested Foreign Bodies, Enterocutaneous Fistula (three-phase management), Pneumatosis Intestinalis (“a radiographic finding, not a diagnosis”), Blind Loop Syndrome, Radiation Enteritis (acute/chronic forms, prevention, treatment), and Short Bowel Syndrome (adaptive hyperplasia, teduglutide, Bianchi/STEP procedures, intestinal transplantation), plus Vascular Compression of the Duodenum (SMA Syndrome).
  • Rewrote wiki/Overview.md (previously stale, still saying “no sources ingested yet”) with a current synthesis: what’s in the wiki, the textbook-vs-primary-literature depth asymmetry across topics, and open next steps.
  • Updated index.md, conditions/sources landing pages.
  • Ingest list complete. No further sources currently queued — next steps (lint pass, further primary-literature ingest in a specific area, or leaving the wiki as-is) are open and should follow Stephen’s direction.

[2026-08-19] lint | Vault-wide consistency pass

[2026-08-19] ingest | ACG 2025 - Ulcerative Colitis Guideline

  • Ingested the 2025 ACG Clinical Guideline Update: Ulcerative Colitis in Adults (Rubin et al., Am J Gastroenterol 2025;120:1187-1224) — full text, 38 pages, read in 3 chunks.
  • New guideline page: guidelines-trials/ACG 2025 - Ulcerative Colitis Guideline.md (type trial-guideline). Raw PDF filed as raw/Rubin 2025 - ACG Clinical Guideline Update Ulcerative Colitis in Adults.pdf.
  • Substantially expanded conditions/Ulcerative Colitis.md: new “Disease severity and monitoring” section (ACG UC Disease Activity Index, endoscopic-improvement treatment goal, fecal calprotectin as monitoring tool, intestinal ultrasound), new “Medical management” section (mild-moderate stepwise 5-ASA/budesonide/steroid approach; full moderate-severe advanced-therapy roster — anti-TNF, vedolizumab, ustekinumab, IL-23p19 inhibitors, JAK inhibitors, S1P modulators — with UC-specific positioning and trial evidence), new “Acute severe UC (ASUC)” section (full day 0/3/6 management algorithm from the guideline’s Fig. 3). This closes a gap this wiki’s own lint pass had flagged: UC medical management previously had zero primary-literature/guideline backing.
  • Flagged and corrected an older-teaching point on the existing surgical-indications section: the guideline states neither infliximab nor cyclosporine rescue therapy increases postoperative colectomy complications, and surgery should not be delayed for a biologic “washout” — added as an explicit note rather than silently overwriting the prior fulminant-colitis text.
  • Updated conditions/Inflammatory Bowel Disease.md’s open items to flag the new UC/Crohn’s asymmetry in medical-management sourcing (UC now guideline-backed, Crohn’s still textbook-only).
  • Updated index.md and guidelines-trials/Guidelines & Trials.md.
  • Not yet cross-checked against the other two guidelines Stephen provided in the same batch (AGA Living Guideline on IBD Pharmacotherapy; British IBD 2025) — both queued for ingest next. Any disagreement between the three will be flagged explicitly once read.

[2026-08-19] ingest | AGA 2024 - Moderate-to-Severe UC Pharmacotherapy Guideline

  • Ingested the AGA Living Clinical Practice Guideline on Pharmacological Management of Moderate-to-Severe Ulcerative Colitis (Singh et al., Gastroenterology 2024;167:1307-1343) — full text, 37 pages, read in 3 chunks.
  • New guideline page: guidelines-trials/AGA 2024 - Moderate-to-Severe UC Pharmacotherapy Guideline.md (type trial-guideline). Raw PDF filed as raw/Singh 2024 - AGA Living Guideline Pharmacological Management Moderate-Severe UC.pdf.
  • Expanded conditions/Ulcerative Colitis.md’s Medical management section: new “Efficacy positioning” subsection and new “Combination therapy, de-escalation, and sequencing” subsection.
  • Flagged an explicit cross-guideline methodological disagreement (not silently merged): the ACG 2025 guideline declines to rank therapies via network meta-analysis; this AGA guideline builds its entire higher/intermediate/lower efficacy-bucket system substantially on NMA p-scores. Documented as its own subsection on Ulcerative Colitis with both guidelines’ positioning tables shown side by side rather than merged into one ranking.
  • Updated index.md and guidelines-trials/Guidelines & Trials.md.
  • Still queued: British IBD 2025 guideline (102pp) — the third and largest of the batch Stephen provided. Once ingested, cross-check all three for further agreement/disagreement.

[2026-08-19] ingest | BSG 2025 - IBD Guidelines (Adults)

  • Ingested the British Society of Gastroenterology guidelines on the management of IBD in adults (Moran et al., Gut 2025;74:s1-s101) — full text, 102 pages (references start ~p.87), read in 5 chunks. By far the broadest of the three guidelines in this batch: covers both UC and Crohn’s plus extensive cross-cutting content.
  • New guideline page: guidelines-trials/BSG 2025 - IBD Guidelines (Adults).md (type trial-guideline). Raw PDF filed as raw/Moran 2025 - BSG Guidelines on the Management of IBD in Adults.pdf.
  • Substantially expanded conditions/Crohn Disease.md — closes the wiki’s single biggest IBD gap. New “Advanced therapy, monitoring, and post-surgical management” section: full GRADE-based advanced-therapy roster (adalimumab/infliximab with combination-therapy recommendations, ustekinumab, risankizumab, upadacitinib suggested; vedolizumab NOT suggested — a genuine disease-specific divergence from its favorable UC positioning, flagged explicitly as different from the ACG/AGA methodology disagreement), TDM specifics (purine metabolite and anti-TNF trough targets), EEN practical protocol, withdrawal-of-thertherapy guidance, post-surgical recurrence prevention (anti-TNF/vedolizumab within 90 days for high-risk patients), perioperative optimization. Also expanded the existing Perianal disease bullet with BSG’s perianal Crohn’s workup/treatment guidance (PISA-II trial, infliximab first-line, failed MSC therapy trial).
  • Expanded conditions/Inflammatory Bowel Disease.md with cross-cutting content applicable to both diseases: new “Therapeutic drug monitoring”, “Pregnancy”, and “Perioperative management and superadded infection” sections; expanded “Extraintestinal manifestations” with PSC-IBD detail (annual surveillance colonoscopy timing) and spondyloarthropathy drug-specific guidance (which biologics to avoid).
  • Light-touch note added to conditions/Ulcerative Colitis.md acknowledging BSG’s UC content exists but wasn’t exhaustively cross-checked against ACG/AGA-sourced specifics during this ingest — flagged as an explicit limitation rather than silently assumed consistent.
  • Updated index.md and guidelines-trials/Guidelines & Trials.md.
  • This completes the 3-guideline batch Stephen provided (ACG 2025, AGA 2024, BSG 2025). All three now cross-reference each other’s positioning differences explicitly where they exist (ACG-vs-AGA: NMA methodology disagreement on UC; BSG: genuine efficacy-based vedolizumab divergence in Crohn’s vs. UC).

[2026-08-19] ingest | 8 primary-literature trials — rectal cancer TNT cluster + NET cluster

  • Ingested 8 primary-literature papers Stephen uploaded, closing the gaps flagged in this wiki’s Open items after the earlier WebFetch-failure episode: 4 rectal-cancer neoadjuvant trials (RAPIDO, PRODIGE 23 long-term, STELLAR, PROSPECT) and 4 neuroendocrine-tumor trials (CLARINET, PROMID, RADIANT-4, NETTER-1).
  • Filename correction: the uploaded NEJMoa2303269_RAPIDO.pdf is, despite its name, the PROSPECT trial (Schrag et al., NEJM 2023) — confirmed via DOI and full-text content, not the RAPIDO trial. The actual RAPIDO trial (Bahadoer et al., Lancet Oncol 2021) was separately uploaded as RAPIDO.pdf. Flagged explicitly in sources/Schrag 2023 - PROSPECT Trial.md.
  • New source pages (all type: source, raw PDFs filed under raw/): sources/Bahadoer 2021 - RAPIDO Trial.md, sources/Conroy 2024 - PRODIGE 23 Long-Term Results.md, sources/Jin 2022 - STELLAR Trial.md, sources/Schrag 2023 - PROSPECT Trial.md, sources/Caplin 2014 - CLARINET Trial.md, sources/Rinke 2009 - PROMID Trial.md, sources/Strosberg 2017 - NETTER-1 Trial.md, sources/Yao 2016 - RADIANT-4 Trial.md.
  • Substantially updated concepts/Total Neoadjuvant Therapy (TNT).md — Efficacy section rebuilt around a 3-trial comparison table (RAPIDO/PRODIGE23/STELLAR). Key finding to flag: the locoregional-recurrence trade-off previously described (from the Boublikova secondary review) as a general feature of TNT turns out to be RAPIDO-specific, not a consistent cross-trial finding — PRODIGE 23 and STELLAR both show numerically better, not worse, local control with TNT vs. standard CRT. Documented as an explicit unresolved cross-source disagreement per this wiki’s contradiction-flagging convention, not silently resolved. OS benefit is similarly trial-dependent: clear/mature in PRODIGE 23, non-powered trend in STELLAR, absent in RAPIDO (partly attributed to an “ATRESS phenomenon” not observed in PRODIGE 23).
  • Updated conditions/Rectal Cancer.md — new “Neoadjuvant trial evidence: TNT and radiation- omission” section summarizing the 4 trials’ treatment-selection implications; Open items updated (POLISH II and the IDEA duration collaboration remain the only un-ingested primary trials in this area).
  • Updated conditions/Small Bowel Neuroendocrine Tumors (NETs).md — Medical therapy section rewritten with precise primary-source figures replacing the prior textbook-only narrative (PROMID: TTP 14.3 vs 6.0mo, HR 0.34; CLARINET: PFS not reached vs 18.0mo, HR 0.47; RADIANT-4: PFS 11.0 vs 3.9mo, HR 0.48 — confirmed accurate against the textbook’s prior paraphrase; NETTER-1: HR 0.21, PFS not reached vs 8.4mo — corrected the textbook’s “79% PFS improvement” framing to the more precise “79% lower risk of progression/death”). Open items updated — TELESTAR remains un-ingested.
  • Updated index.md and sources/Sources.md with all 8 new source entries.
  • Not pursued: no new guidelines-trials/ trial-entity pages were created for these 8 papers (unlike the SCANDIV/Ladies Trial precedent) — TNT.md and the NETs condition page already serve as adequate synthesis anchors and previously narratively referenced these trials, so separate entity pages would be redundant at this scope.

[2026-08-19] lint | Full wiki lint pass

  • Broken links: none. Checked every [[wikilink]] against filenames and frontmatter aliases (Obsidian resolves via both) — [[Ladies Trial]] (9 instances) correctly resolves to Ladies Trial (LOLA).md via its declared alias; not actually broken.
  • Orphan pages: none — every page has at least one inbound link.
  • Landing-page and index.md completeness: all 5 folder landing pages list every page in their folder, and index.md catalogs every page across all folders. No gaps found.
  • Frontmatter: the 5 folder landing pages (Sources.md, Conditions.md, Concepts.md, Procedures.md, Guidelines & Trials.md) have no YAML frontmatter, consistent with index.md/log.md/Overview.md. Treated as by-design (pure navigation pages, don’t fit the type: enum) rather than a defect — flagged to Stephen, no change made pending his decision on whether to codify this exemption explicitly in CLAUDE.md.
  • Superseded claim, fixed: conditions/Appendiceal Neoplasms.md’s “Advanced/metastatic disease” section and Open items still described PROMID/CLARINET/RADIANT-4/NETTER-1 as un-ingested, secondhand-only (via Hoehn’s review) — stale as of the 2026-08-19 8-paper ingest. Updated to cite the primary source pages directly, cross-link to Small Bowel Neuroendocrine Tumors (NETs)‘s Medical therapy synthesis, and note these trials studied midgut/GI NET populations generally rather than appendiceal NETs specifically (Hoehn extrapolates). RADIANT-2 noted as still not independently ingested. Frontmatter sources[] expanded accordingly.
  • Stale aside, fixed: guidelines-trials/ACG 2025 - Ulcerative Colitis Guideline.md’s Relevance section said NETTER-1/PROMID/CLARINET/RADIANT-4 “remain unaddressed” — no longer true after the same ingest. Reworded to note they were independently ingested separately, with a cross-link to the NETs page.
  • Concept gaps (MRF, EMVI, pCR lacking standalone pages): already self-flagged in Rectal Cancer.md and Total Neoadjuvant Therapy (TNT).md’s own Open items from the prior ingest — not a new finding.
  • Web-search-worthy gaps: not pursued without sign-off. Largest remaining: POLISH II (TNT) and RAPIDO’s 5-year follow-up (Dijkstra et al., Ann Surg 2023), both already noted as open items.

[2026-08-19] query | Research priorities synthesis

  • Stephen asked what studies are needed to expand the knowledge base. Swept every page’s “Open items / gaps” section (~40 pages) and synthesized into a new tracking page, wiki/Research Priorities.md — a checkbox-organized punch list grouped into: named studies that resolve a specific already-flagged gap (RAPIDO 5-year follow-up, POLISH II, IDEA duration collaboration, TELESTAR, RADIANT-2, DILALA, LapLAND, SCANDIV 90-day/1-year reports, PRODIGE 7, COLOPEC, mitomycin-vs-oxaliplatin RCT, BALLAD, Crohn’s-specific ACG/AGA guidelines, IDSA/SHEA C. diff guideline); condition pages with zero primary literature (Appendiceal Neoplasms’ non-NET subtypes, GIST, Short Bowel Syndrome, Radiation Enteritis, Enterocutaneous Fistula, Meckel Diverticulum, Rectal Prolapse/Rectocele/SRUS, hereditary CRC syndromes); and contested clinical questions worth a dedicated source (stenting-as-bridge for obstructing colon cancer, antibiotics-vs-none for uncomplicated diverticulitis, taTME long-term outcomes vs. conventional TME). Placed at wiki/ root (no frontmatter, alongside index.md/log.md/Overview.md) since it’s a meta/tracking page, not an entity page — doesn’t fit the type: enum. Not added to index.md’s catalog, consistent with how index.md excludes the other root meta pages.

[2026-08-20] ingest | 5 primary-literature trials — RAPIDO 5-yr follow-up, POLISH II, PRODIGE 7,

GRECCAR16 and JANUS protocols

  • Stephen uploaded 5 papers directly requested from Research Priorities’s punch list: GRECCAR16, JANUS, POLISH II, PRODIGE7, and “RAPIDO 5yr” (the actual filenames matched their content — no mislabeling this time).
  • New source pages: Ciseł 2019 - POLISH II Long-Term Results, Dijkstra 2023 - RAPIDO 5-Year Locoregional Failure, Quénet 2021 - PRODIGE 7 Trial, Brouquet 2020 - GRECCAR16 Trial Protocol, Alvarez 2024 - JANUS Trial Protocol.
  • GRECCAR16 and JANUS turned out to be study-protocol papers, not results papers — flagged explicitly on their own source pages and in Total Neoadjuvant Therapy (TNT): GRECCAR16 (FOLFIRINOX replacing radiotherapy entirely vs. standard CRT, N=574 target, no results yet) and JANUS (Alliance A022104/NRG-GI010: triplet vs. doublet consolidation chemotherapy after LCRT for cCR/DFS, 330/760 accrued as of May 2024, no results yet). Both were previously known to the wiki only as vague “ongoing trial” mentions in the Boublikova review / PRODIGE 23’s discussion — now their actual design, primary endpoints, and rationale are documented, even though efficacy data remains pending.
  • Dijkstra 2023 - RAPIDO 5-Year Locoregional Failure resolves this wiki’s most significant open question: at 5.6-year follow-up, RAPIDO’s locoregional recurrence rate with TNT is now statistically significantly higher than with standard CRT (10.2% vs 6.1% after R0/R1 resection, P=0.027) — this was only a non-significant numerical trend at the original 3-year analysis. The systemic-control benefit (disease-related treatment failure, distant metastases) remains durable at 5 years; OS remains unchanged between arms. This confirms the locoregional trade-off as a real, RAPIDO-specific finding — still not observed in PRODIGE 23 or STELLAR.
  • Ciseł 2019 - POLISH II Long-Term Results adds a fourth trial to the cross-trial TNT comparison table, and it’s a genuine outlier: a truly neutral result — no OS, DFS, local-control, or distant-metastasis difference in either direction at 8 years, and an early 3-year OS advantage for the short-course/consolidation-chemo arm that did not persist. Useful counterexample against over-generalizing from the other three trials.
  • Quénet 2021 - PRODIGE 7 Trial closes the “no primary HIPEC trial data” gap on Cytoreductive Surgery and HIPEC — confirms no OS/RFS benefit from adding HIPEC to CRS for colorectal peritoneal metastases (previously known only via a secondary review), and adds a new detail not previously in the wiki: HIPEC was associated with significantly more morbidity at 60 days (26% vs 15%, P=0.035).
  • Updated: concepts/Total Neoadjuvant Therapy (TNT).md (Efficacy table now has 4 trials + RAPIDO 5-yr row, trade-off framing rewritten as “confirmed RAPIDO-specific, not a class effect”, Modalities section updated with actual JANUS/GRECCAR16 protocol detail, Open items updated); conditions/Rectal Cancer.md (Neoadjuvant trial evidence section rewritten with 5-year RAPIDO data and POLISH II, Open items updated); concepts/Cytoreductive Surgery and HIPEC.md (PRODIGE 7 primary data replaces secondhand summary, Open items updated); Research Priorities.md (checked off POLISH II, RAPIDO 5-yr, PRODIGE 7, GRECCAR16/JANUS protocols; added ACO/ARO/AIO-18 and GRECCAR 14 as still-secondhand-only); sources/Sources.md, index.md updated with all 5 new entries.
  • Not pursued: no new guidelines-trials/ entity pages created for these 5 papers, consistent with the precedent set during the 2026-08-19 8-paper ingest — the relevant concept/condition pages already serve as synthesis anchors.

[2026-08-20] lint | Post-ingest consistency pass

  • Full 6-category lint pass (contradictions, superseded claims, orphans/broken links, missing concept pages, missing cross-references, gaps) plus a frontmatter/index spot-check, run after the 2026-08-20 5-paper ingest. No contradictions, no orphan pages, no broken links, index fully accurate — findings were all staleness/gaps left behind by that ingest, not caught by the prior (pre-ingest) lint pass. All fixes below applied per Stephen’s “apply all” instruction.
  • Fixed 5 stale “not yet ingested” notes that a same-day or next-day ingest had since resolved: sources/Bahadoer 2021 - RAPIDO Trial.md (now points to Dijkstra 2023 - RAPIDO 5-Year Locoregional Failure as confirming, not secondhand, the 5-year trade-off); sources/Vennix 2015 - Ladies Trial LOLA.md (now links Lambrichts 2019 - LADIES DIVA Trial as ingested); guidelines-trials/ACG 2025 - Ulcerative Colitis Guideline.md and guidelines-trials/AGA 2024 - Moderate-to-Severe UC Pharmacotherapy Guideline.md (both now note the AGA/BSG and BSG cross-checks are done, pointing to Ulcerative Colitis’s synthesis); conditions/Ulcerative Colitis.md (deleted an Open items bullet that contradicted the correct bullet two lines below it).
  • Added 2 missing cross-references: conditions/Rectal Cancer.md’s metastatic-disease section now points to Cytoreductive Surgery and HIPEC for peritoneal spread; conditions/Appendiceal Neoplasms.md now links Colon Cancer Resection for right-hemicolectomy technique and its Open items bullet (which wrongly claimed no such page existed) is corrected.
  • Frontmatter cleanup: Overview.md was missing created: — added (2026-08-18, the vault scaffold date); type: overview added to CLAUDE.md’s declared type enum to match. Research Priorities.md given tags: [meta] frontmatter, consistent with the other 8 meta/landing pages tagged earlier this session.
  • Rewrote Overview.md (per its own stated convention — rewritten, not appended to) to reflect the full current state: the four primary-literature clusters (rectal cancer TNT, diverticulitis, appendiceal/NET, IBD guidelines), three completed lint passes, and Research Priorities.md as the live gap-tracker, replacing the 2026-08-19 snapshot that predated this session’s ingest.
  • Added 2 new tracked gaps to Research Priorities.md: OPRA trial (referenced by name in 3 pages as the key NOM/organ-preservation data point, never independently ingested) and VARSITY trial (the one head-to-head UC biologic RCT both ACG and AGA guidelines lean on, known only secondhand).
  • Not changed: the “Colon Cancer as its own condition page” question raised in the lint report — a judgment call flagged for Stephen’s input, not a clear defect, so left as-is pending direction.

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