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Colorectal Cancer and Crohn’s Colitis: Clinical Implications From 313 Surgical Patients

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Abstract

Background

The relation between Crohn’s colitis (CC) and colorectal cancer is still controversial. Several case reports and retrospective studies have shown that patients with Crohn’s disease (CD) have a 6- to 20-fold higher risk to develop CRC than does the normal population. The extent of disease (extensive colitis), presence of anal fistula, age > 40 years, strictures, and length of disease >10 years may be important determinants for increasing risk. Despite this evidence, other population-based studies have shown no increased risk of colon or rectal cancer. The aim of this study was to investigate retrospectively factors that may predict the development of cancer.

Methods

We searched the histopathologic database of the Digestive Surgery Unit at Careggi University Hospital for CC patients (January 1987 to September 2011) and identified 313 patients with CC who underwent surgery.

Results

There are 11 (3.5 %) of adenocarcinomas. Multivariate analysis showed disease duration (p = 0.001), age at CD diagnosis (p = 0.002), distal localization (p = 0.045), and penetrating disease (p = 0.041) to be risk factors. Multivariate analysis showed that 40 patients who had undergone previous immunosuppressive therapy had a significant risk of developing CRC (p = 0.026).

Conclusions

Crohn’s colitis patients who require surgery are at higher risk for developing CRC, particularly those whose disease duration is >10 years, have distal localization, age at diagnosis was <40 years, and have penetrating disease. Previous immunosuppressive therapy should be better investigated. We recommend surgery for any patient presenting with colonic strictures.

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Acknowledgments

Thanks go to the Association of Italian Cancer Registries (AIRTUM), and particularly to Dr. Emanuele Crocetti for providing data of colorectal cancer incidence and survival in general population. In memory of Professor Andrea Tropea, surgeon and friend.

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Correspondence to Stefano Scaringi.

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Scaringi, S., Di Martino, C., Zambonin, D. et al. Colorectal Cancer and Crohn’s Colitis: Clinical Implications From 313 Surgical Patients. World J Surg 37, 902–910 (2013). https://doi.org/10.1007/s00268-013-1922-z

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