title: Colonic diverticulitis in chemotherapy patients: should operative indications change? A retrospective cohort study.
abstract: BACKGROUND
  Management of the immunosuppressed patient with diverticular disease remains controversial. We report the largest series of colon cancer patients undergoing chemotherapy and hospitalized for acute diverticulitis, to determine whether recent treatment with systemic chemotherapy is associated with increased risk for/increased severity of recurrent diverticulitis.
  
  
  METHODS
  Retrospective cohort study of adult patients hospitalized for an initial episode of acute colonic diverticulitis at Memorial Sloan Kettering Cancer Center, 1988-2004. Outcomes in patients receiving systemic chemotherapy within one month of admission for diverticulitis ("Chemo") were compared to outcomes of patients not receiving chemotherapy within the past month ("No-chemo").
  
  
  RESULTS
  A total 131 patients met inclusion criteria. Chemo patients did not differ significantly from No-chemo group in terms of severity of acute diverticulitis at index admission (13.2% vs. 4.4%, respectively, p = 0.12), resumption of chemotherapy (median 2 months), failure of non-operative management (13.2% vs 4.4%, respectively, p = 0.12), frequency of recurrence (20.5% vs 18.5%), hospital length of stay (p = 0.08), and likelihood of interval resection (24.0% vs. 16.2%, respectively, p = 0.39). Chemo patients recurred with more severe disease, were more likely to undergo emergent surgery (75.0% vs. 23.5%, respectively, p = 0.03), and were more likely to be diverted (100.0% vs. 25.0%, respectively, p = 0.03). Chemo patients were significantly more likely to incur a postoperative complication (100% vs 9.1% p < 0.01) following interval resection. Overall mortality was significantly higher in the Chemo vs. No-chemo group. Median survival in Chemo patients was 3.4 years; in No-chemo patients, median survival was not reached at 10 years.
  
  
  CONCLUSIONS
  Our data do not support routine elective surgery for acute diverticulitis in patients receiving chemotherapy. Non-operative management in the acute or interval setting appears preferable whenever possible.
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
authors.forename: Tushar
authors.initials: T
authors.lastname: Samdani
authors.affiliation: Departments of Surgery and Public Health, Weill Cornell Medical College, 445 East 69th Street, New York, NY 10065, USA.
authors.forename: Fredric M
authors.initials: FM
authors.lastname: Pieracci
authors.affiliation: Departments of Surgery and Public Health, Weill Cornell Medical College, 445 East 69th Street, New York, NY 10065, USA.
authors.forename: Soumitra R
authors.initials: SR
authors.lastname: Eachempati
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
authors.forename: Jaime
authors.initials: J
authors.lastname: Benarroch-Gampel
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
authors.forename: Alex
authors.initials: A
authors.lastname: Weiss
authors.affiliation: Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
authors.forename: M Cathy
authors.initials: MC
authors.lastname: Pietanza
authors.affiliation: Departments of Surgery and Public Health, Weill Cornell Medical College, 445 East 69th Street, New York, NY 10065, USA.
authors.forename: Philip S
authors.initials: PS
authors.lastname: Barie
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA. Electronic address: nashg@mskcc.org.
authors.forename: Garrett M
authors.initials: GM
authors.lastname: Nash
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003110:Colonic Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D004239:Diverticulitis, Colonic / Q000150:complications / Q000601:surgery*; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies
chemical_list: D000970:Antineoplastic Agents
keywords: Colon cancer; Immunosuppression; Interval resection; Morbidity; Recurrence