Tumour Characteristics of Patients with Colorectal Cancer after Acute Uncomplicated Diverticulitis

Abstract

Background: The association between diverticulitis and colorectal cancer (CRC) remains unclear, though both share epidemiological characteristics. The aim of this study was to investigate whether there is higher risk for CRC after an episode of uncomplicated diverticulitis. Furthermore, in cases of CRC, we sought to determine specific tumour characteristics. Methods: This retrospective observational study includes patients with acute diverticulitis (Hinchey 0 and 1) who were conservatively treated with or without antibiotics between 2008 and 2013. Patients with endoscopic follow-up were included for analysis. Tumour characteristics of patients diagnosed with CRC during colonoscopic follow-up according to patients’ presentation of alarm symptoms were considered to be the primary endpoint. Results: A total of 977 patients were conservatively treated for an episode of acute diverticulitis, 645 of whom underwent colonoscopy during follow-up. Ten patients were diagnosed with CRC, nine of whom exhibited alarm symptoms. One patient was diagnosed with stage I disease, 4 had stage II, and 5 had stage III disease. Conclusions: This study strongly suggests that even though CRC is rare after uncomplicated diverticulitis, in cases of alarm symptoms, a colonoscopy is indicated. In cases where CRC is diagnosed, it is often advanced with a higher TNM stage and poor prognosis.

High Probability of an Underlying Colorectal Cancer Among Patients Treated for Acute Diverticulitis. A Population‐Based Cohort Follow‐Up Study

“…Similar to our results, persisting alarm symptoms are also commonly reported in patients with colorectal disease at follow‐up [25, 34]. This information is however based on retrospective information collected at the follow‐up suggesting high risk of recall bias.…”

Efficacy of colonoscopy after an episode of acute diverticulitis and risk of colorectal cancer

“…Multidetector CT can obtain thinner sections and has a better resolution and images of higher quality [6,17]. It is presently considered the best imaging technique for the diagnosis of AD and its complications, with a sensitivity and specificity of 94% and 99% respectively [4,18,19].…”

Management of Diverticulitis

“…In fact, rates of colon cancer detection after uncomplicated diverticulitis are similar to detection rates in the average risk screening population [63][64][65]. When colon cancer is detected after uncomplicated diverticulitis, it is typically associated with alarm symptoms and higher TNM stage [66].…”