Predictors of underlying carcinoma in patients with suspected acute diverticulitis

Abstract

BackgroundA subset of patients who undergo colon resection for suspected diverticulitis will unexpectedly be found to have cancer. We hypothesized that a subset of variables could be used to help predict a diagnosis of cancer preoperatively. MethodsNational Surgical Quality Improvement Program data (2012–2018) were used to identify all patients with a preoperative diagnosis of diverticulitis who had unexpected cancer using postoperative staging data. Key characteristics of the study groups were compared with χ2 tests and multivariate logistic regression modeling. ResultsA total of 17,368 patients were identified with an operative indication of acute diverticulitis. Of these, 164 (0.94%) had an unexpected postoperative diagnosis of cancer. Most cancer patients had locally advanced tumors (T1–2: 15%; T3: 39%; T4: 45%), and 37.1% had positive lymph nodes. Rates of margin positivity and inadequate lymph node harvest were 1.2% and 15.9%, respectively. In bivariate analyses, cancer patients had increased age (P < .01), decreased albumin (P < .001), and increased rates of preoperative anemia (P = .01), sepsis (P < .01), and weight loss (>10% in 6 months) (P < .001). The only variables significantly associated with cancer in multivariate regression analysis were sepsis (odds ratio 2.14, 95% confidence interval [1.3–3.6]; P < .01), weight loss (odds ratio 2.31, 95% confidence interval [1.1–4.4]; P = .01), and preoperative albumin level (odds ratio 0.64, 95% confidence [0.45–0.92]; P < .01). ConclusionAn unexpected postoperative diagnosis of cancer occurs in a small percentage of patients with suspected diverticulitis. Surgeons should have a high index of suspicion for cancer in patients with sepsis or malnutrition.