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The incidence of colon cancer among patients diagnosed with left colonic or sigmoid acute diverticulitis is higher than in the general population

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Abstract

Background

Considering the low incidence of colon cancer after an initial episode of colonic diverticulitis in some categories of patients, some authors suggested to exempt them from colonoscopy. However, this incidence has never been compared to that of a reference population, and predictors of cancer are still poorly investigated. We aimed to determine the 1-year incidence of colon cancer at the site of diverticulitis in patients diagnosed with left colonic or sigmoid acute diverticulitis, to compare this incidence to a reference population to state whether endoscopy is required or not, and to identify predicting factors of cancer to better target subpopulations needing that examination.

Methods

All patients admitted at the University Hospitals of Geneva for left colonic or sigmoid acute diverticulitis were included. Patients with a previous history of colon cancer or non-available for follow-up were excluded. Demographic data, haemoglobin values, and the Hinchey score were documented. This cohort was matched with the Geneva Cancer Registry to look for cancer occurrence at the site of diverticulitis within 1 year. Predictors of cancer were assessed using univariate logistic regression and the risk of cancer by comparing observed cases to a reference population using standardized incidence ratios.

Results

The final cohort included 506 patients. Eleven (2.2 %) had a diagnosis of cancer at the site of diverticulitis within 1 year. The mean age was significantly different between patients with cancer and others. No predictor of cancer could be identified, except a trend for an increased risk with advancing age (p = 0.067). The standardized incidence ratios showed a 44-fold increased risk of cancer among the cohort compared to the reference population.

Conclusions

Colonoscopy should be continued after an initial diagnosis of left colonic or sigmoid acute diverticulitis, irrespective of the clinical or radiological presentations.

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Abbreviations

CI:

Confidence interval

CT:

Computed tomography

Hb:

Haemoglobin

OR:

Odds ratio

SD:

Standard deviation

SIR:

Standardized incidence ratio

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Acknowledgments

The authors are grateful to Dr. Olivier Huber, MD, for his contribution to the conception of the study, and to Prof. Thomas Perneger, MD, for reviewing the statistical analysis.

Disclosures

Drs. Jeremy Meyer, Theodoros Thomopoulos, Massimo Usel, Ergys Gjika, Christine Bouchardy, Philippe Morel and Frederic Ris have no conflict of interest or financial ties to disclose.

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Authors and Affiliations

  1. Clinic for Visceral and Transplantation Surgery, Department of Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland

    Jeremy Meyer, Theodoros Thomopoulos, Ergys Gjika, Philippe Morel & Frédéric Ris

  2. Geneva Cancer Registry, Global Health Institute, University of Geneva, Boulevard de la Cluse 55, 1205, Geneva, Switzerland

    Massimo Usel & Christine Bouchardy

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  1. Jeremy Meyer
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  2. Theodoros Thomopoulos
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Correspondence to Jeremy Meyer.

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Meyer, J., Thomopoulos, T., Usel, M. et al. The incidence of colon cancer among patients diagnosed with left colonic or sigmoid acute diverticulitis is higher than in the general population. Surg Endosc 29, 3331–3337 (2015). https://doi.org/10.1007/s00464-015-4093-1

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  • DOI: https://doi.org/10.1007/s00464-015-4093-1

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