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Underlying Colorectal Cancer Was Rarely Detected After an Episode of Acute Diverticulitis: a Retrospective Analysis of 225 Patients

  • Tawfik KhouryEmail author
  • Mahmud Mahamid
  • Ahmad Lubany
  • Mohammad Safadi
  • Amir Farah
  • Wisam Sbeit
  • Amir Mari
Original Research
  • 28 Downloads

Abstract

Purpose

The aim of the present study was to determine the prevalence of underlying colorectal carcinoma (CRC) in a cohort of patients who experienced an episode of acute diverticulitis and to assess clinical and laboratory parameters that suggest CRC diagnosis.

Methods

We performed a single center retrospective study in EMMS Nazareth Hospital from April 2014 to April 2018. All Patients who experienced an episode of acute diverticulitis and underwent a colonoscopy up to 6-month period were included in the study.

Results

Two hundred twenty-five patients (225) patients were included. The mean age was 55.73 ± 13.81 (24–93). One hundred thirty-nine (139) patients were males. Underlying CRC was diagnosed in 2 out of 225 (0.89%) patients and colonic polyps were found in 17 out of 225 patients (7.56%). The average time interval between the episode of diverticulitis and the performance of colonoscopy was 6 weeks. Male gender was significantly associated with CRC and polyp findings (P = 0.039). Moreover, platelet count (353,000 vs. 234,000, P = 0.002) and platelet to lymphocyte ratio (223.65 vs. 127.4, P = 0.015) showed statistically significant correlation with CRC as compared to colonic polyps.

Conclusion

The rate of underlying CRC diagnosis was extremely low after an episode of acute diverticulitis. Male gender and platelet to lymphocyte ratio were predictors for the presence of underlying CRC.

Keywords

Diverticulitis Colon Cancer Rate 

Abbreviations

CRC

colorectal cancer

CT

computed tomography

ICD

International Statistical Classification of Diseases

WBC

white blood cells

Hb

hemoglobin

SD

standard deviation

MMP-9

metalloproteinase-9

Notes

Compliance with Ethical Standards

The study was approved by the local institutional ethic committee. Written informed consent was waived due to the retrospective non-interventional study design.

Conflict of Interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Peppas G, Bliziotis IA, Oikonomaki D, Falagas ME. Outcomes after medical and surgical treatment of diverticulitis: a systematic review of the available evidence. J Gastroenterol Hepatol. 2007;22(9):1360–8.CrossRefGoogle Scholar
  2. 2.
    Stollman N, Raskin JB. Diverticular disease of the colon. Lancet. 2004;363(9409):631–9.CrossRefGoogle Scholar
  3. 3.
    Stefansson T, Ekbom A, Sparen P, Pahlman L. Increased risk of left sided colon cancer in patients with diverticular disease. Gut. 1993;34(4):499–502.CrossRefGoogle Scholar
  4. 4.
    Stefansson T, Ekbom A, Sparen P, Pahlman L. Association between sigmoid diverticulitis and left-sided colon cancer: a nested, population-based, case control study. Scand J Gastroenterol. 2004;39(8):743–7.CrossRefGoogle Scholar
  5. 5.
    Granlund J, Svensson T, Granath F, Hjern F, Ekbom A, Blomqvist P, et al. Diverticular disease and the risk of colon cancer - a population-based case-control study. Aliment Pharmacol Ther. 2011;34(6):675–81.CrossRefGoogle Scholar
  6. 6.
    Ekbom A. Is diverticular disease associated with colonic malignancy? Dig Dis. 2012;30(1):46–50.CrossRefGoogle Scholar
  7. 7.
    Lau KC, Spilsbury K, Farooque Y, Kariyawasam SB, Owen RG, Wallace MH, et al. Is colonoscopy still mandatory after a CT diagnosis of left-sided diverticulitis: can colorectal cancer be confidently excluded? Dis Colon Rectum. 2011;54(10):1265–70.CrossRefGoogle Scholar
  8. 8.
    Jacobs DO. Clinical practice. Diverticulitis N Engl J Med 2007;357(20):2057–2066.Google Scholar
  9. 9.
    Westwood DA, Eglinton TW, Frizelle FA. Routine colonoscopy following acute uncomplicated diverticulitis. Br J Surg. 2011;98(11):1630–4.CrossRefGoogle Scholar
  10. 10.
    Gatto NM, Frucht H, Sundararajan V, Jacobson JS, Grann VR, Neugut AI. Risk of perforation after colonoscopy and sigmoidoscopy: a population-based study. J Natl Cancer Inst. 2003;95(3):230–6.CrossRefGoogle Scholar
  11. 11.
    Daniels L, Unlu C, de Wijkerslooth TR, Dekker E, Boermeester MA. Routine colonoscopy after left-sided acute uncomplicated diverticulitis: a systematic review. Gastrointest Endosc. 2014;79(3):378–89 quiz 498–498 e375.CrossRefGoogle Scholar
  12. 12.
    Sharma PV, Eglinton T, Hider P, Frizelle F. Systematic review and meta-analysis of the role of routine colonic evaluation after radiologically confirmed acute diverticulitis. Ann Surg. 2014;259(2):263–72.CrossRefGoogle Scholar
  13. 13.
    Zulli C, Maurano A, Tammaro S. Endoscopic closure of a rectal diverticulum perforation during a diagnostic colonoscopy. Acta Gastroenterol Belg. 2015;78(3):344–5.Google Scholar
  14. 14.
    Lahat A, Yanai H, Menachem Y, Avidan B, Bar-Meir S. The feasibility and risk of early colonoscopy in acute diverticulitis: a prospective controlled study. Endoscopy. 2007;39(6):521–4.CrossRefGoogle Scholar
  15. 15.
    Anderson JC, Messina CR, Cohn W, Gottfried E, Ingber S, Bernstein G, et al. Factors predictive of difficult colonoscopy. Gastrointest Endosc. 2001;54(5):558–62.CrossRefGoogle Scholar
  16. 16.
    Liang J, Kalady MF, Church J. Young age of onset colorectal cancers. Int J Color Dis. 2015;30(12):1653–7.CrossRefGoogle Scholar
  17. 17.
    Chan DKH, Tan KK. There is no role for colonoscopy after diverticulitis among Asian patients less than 50 years of age. Gastrointest Tumors. 2017;3(3–4):136–40.Google Scholar
  18. 18.
    Lee D, Jung KU, Kim HO, Kim H, Chun HK. Association between oral health and colorectal adenoma in a screening population. Medicine (Baltimore). 2018;97(37):e12244.CrossRefGoogle Scholar
  19. 19.
    Lee JS, Kim NY, Na SH, Youn YH, Shin CS. Reference values of neutrophil-lymphocyte ratio, lymphocyte-monocyte ratio, platelet-lymphocyte ratio, and mean platelet volume in healthy adults in South Korea. Medicine (Baltimore). 2018;97(26):e11138.CrossRefGoogle Scholar
  20. 20.
    Jenne CN, Urrutia R, Kubes P. Platelets: bridging hemostasis, inflammation, and immunity. Int J Lab Hematol. 2013;35(3):254–61.CrossRefGoogle Scholar
  21. 21.
    Egan K, Crowley D, Smyth P, O'Toole S, Spillane C, Martin C, et al. Platelet adhesion and degranulation induce pro-survival and pro-angiogenic signalling in ovarian cancer cells. PLoS One. 2011;6(10):e26125.CrossRefGoogle Scholar
  22. 22.
    Asher V, Lee J, Innamaa A, Bali A. Preoperative platelet lymphocyte ratio as an independent prognostic marker in ovarian cancer. Clin Transl Oncol. 2011;13(7):499–503.CrossRefGoogle Scholar
  23. 23.
    Krenn-Pilko S, Langsenlehner U, Thurner EM, Stojakovic T, Pichler M, Gerger A, et al. The elevated preoperative platelet-to-lymphocyte ratio predicts poor prognosis in breast cancer patients. Br J Cancer. 2014;110(10):2524–30.CrossRefGoogle Scholar
  24. 24.
    Kwon HC, Kim SH, Oh SY, Lee S, Lee JH, Choi HJ, et al. Clinical significance of preoperative neutrophil-lymphocyte versus platelet-lymphocyte ratio in patients with operable colorectal cancer. Biomarkers. 2012;17(3):216–22.CrossRefGoogle Scholar
  25. 25.
    He W, Yin C, Guo G, Jiang C, Wang F, Qiu H, et al. Initial neutrophil lymphocyte ratio is superior to platelet lymphocyte ratio as an adverse prognostic and predictive factor in metastatic colorectal cancer. Med Oncol. 2013;30(1):439.CrossRefGoogle Scholar
  26. 26.
    Smith RA, Ghaneh P, Sutton R, Raraty M, Campbell F, Neoptolemos JP. Prognosis of resected ampullary adenocarcinoma by preoperative serum CA19-9 levels and platelet-lymphocyte ratio. J Gastrointest Surg. 2008;12(8):1422–8.CrossRefGoogle Scholar
  27. 27.
    Fogar P, Sperti C, Basso D, Sanzari MC, Greco E, Davoli C, et al. Decreased total lymphocyte counts in pancreatic cancer: an index of adverse outcome. Pancreas. 2006;32(1):22–8.CrossRefGoogle Scholar
  28. 28.
    Smith RA, Bosonnet L, Raraty M, Sutton R, Neoptolemos JP, Campbell F, et al. Preoperative platelet-lymphocyte ratio is an independent significant prognostic marker in resected pancreatic ductal adenocarcinoma. Am J Surg. 2009;197(4):466–72.CrossRefGoogle Scholar
  29. 29.
    Kono SA, Heasley LE, Doebele RC, Camidge DR. Adding to the mix: fibroblast growth factor and platelet-derived growth factor receptor pathways as targets in non-small cell lung cancer. Curr Cancer Drug Targets. 2012;12(2):107–23.CrossRefGoogle Scholar
  30. 30.
    Benoy I, Salgado R, Colpaert C, Weytjens R, Vermeulen PB, Dirix LY. Serum interleukin 6, plasma VEGF, serum VEGF, and VEGF platelet load in breast cancer patients. Clin Breast Cancer. 2002;2(4):311–5.CrossRefGoogle Scholar
  31. 31.
    Suzuki K, Aiura K, Ueda M, Kitajima M. The influence of platelets on the promotion of invasion by tumor cells and inhibition by antiplatelet agents. Pancreas. 2004;29(2):132–40.CrossRefGoogle Scholar
  32. 32.
    Jung Y, Joo YE, Kim HG, Jeon SR, Cha JM, Yang HJ, et al. The relationship between the endoscopic withdrawal time and adenoma/polyp detection rate in individual colonic segments: a KASID multicenter study. Gastrointest Endosc. 2018.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Tawfik Khoury
    • 1
    • 2
    • 3
    Email author
  • Mahmud Mahamid
    • 1
    • 2
  • Ahmad Lubany
    • 4
  • Mohammad Safadi
    • 4
  • Amir Farah
    • 4
  • Wisam Sbeit
    • 3
  • Amir Mari
    • 1
    • 2
  1. 1.Gastroenterology and endoscopy unitedThe Nazareth Hospital, EMMSNazarethIsrael
  2. 2.Faculty of medicineBar-Ilan UniversityRamat GanIsrael
  3. 3.Galilee Medical Center, Bar Ilan Faculty of MedicineInstitute of Gastroenterology and Liver DiseasesNahariaIsrael
  4. 4.Department of surgeryThe Nazareth hospital, EMMSNazarethIsrael

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