Diverticular disease and colon cancer: a real association between the two diseases?

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COD: 14_2176_389-396 Categorie: ,

Paolo Del Rio, Matteo Rossini, Cinzia Papadia*, Lorenzo Viani, Domenico Labonia, Mario Sianesi

Ann. Ital. Chir., 2014 85: 389-396

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BACKGROUND: During the last century the incidence of diverticular disease (DD), as well as the prevalence of colonic
adenocarcinoma (ADK), recorded a marked increase in Western populations. In literature has been reported a higher
incidence of sigmoid colon carcinoma associated with diverticular disease suggesting a possible sharing of risk factors and
pathogens between these two pathologies.
MATERIALS AND METHODS: We prospectively examined 165 patients undergoing left colonic resection from May 2010 to
December 2012 at the operating unit of General Surgery and Organ Transplantation of University Hospital of Parma
, dividing them into three groups: affected by left colon cancer (120 cases), affected by complicated diverticular disease
(29 cases) and affected by both diseases (16 cases). In this last group the indication for surgery has always been oncology
based. All cases have been subjected to a 6 months minimum follow-up.
RESULTS: The average age of patients operated for colonic ADK was 69.91 years. The average age of patients operated
for ADK and concomitant DD, compared to that of patients treated for single DD, was statistically higher (73.8 ±
6.89 VS 60.9 ± 13.5, p = 0.004). It was found instead a higher diverticular inflammation degree in patients treated
for DD compared with those treated for ADK associated with DD. No patient with ADK associated with DD showed
hepatic metastases, whereas among patients with just ADK, peritoneal carcinomatosis was recorded in 2.6% of cases and
liver metastases, always synchronous, in 11 .5%. The lymph nodes positivity instead, has presented a prevalence of 33.5%
in patients with ADK and of 7% in patients with associated DD.
CONCLUSION: In our study and its comparison with literature we found in synthesis multiple clinical evidences of a possible
association between the two diseases. The role played by DD would lead to an early diagnosis of colonic ADK. It
remains to be analyzed however the possible etiopathogenetic correlation over time between the two clinical entities, which
actually still remains maybe under random association.

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