Abstract, Academic Surgical Congress 2015: Introduction: Inflammatory bowel disease (IBD) is associated with a high risk of developing colon cancer. Its relationship with the eventual outcomes is less evident, although recent reports have indicated that comorbid IBD may be associated with worse survival. We therefore aimed to review characteristics of colon cancer associated with IBD in our population. Methods: We evaluated outcomes of a patient cohort operated on for colon cancer between 2004 through 2011 in a public tertiary care center in a state providing universal healthcare, focusing on comparing surgical pathological characteristics and long-term outcomes between IBD patients and the remainder of the population. Results: We included 1071 patients, of whom 38 (3.5%) had a concurrent diagnosis of IBD: 21 (2.0%) having Crohn’s, 16 (1.5%) having ulcerative colitis, and 1 patient with a mixed form. IBD patients were significantly younger (median age 59.5 vs. 67 years; P<0.001). These patients had a significantly higher rate of high-grade disease (33.3 vs. 19.4%; P=0.034) and borderline significantly higher rates of AJCC stage I disease (36.8 vs. 24.4%; P=0.06). In terms of outcomes however, no statistically significant differences were encountered between patients with or without IBD. Clinically significant but not statistically significant differences demonstrated lower rates of lymph-node metastasis (31.6 vs. 40.6%; P=0.27) and metastatic presentation (13.2 vs, 17%; P=0.54), as well as better outcomes in terms of metastatic recurrence (9.1 vs. 12.7%; P=0.55), and colon cancer mortality (26.3 vs. 35.6% P=0.27). Point estimates in multivariate analysis adjusted for age and staging where appropriate showed no changes in these trends. Conclusions: IBD patients who develop colon cancer appear to have relatively better staging and outcomes compared to non-IBD patients. These differences were present despite significantly higher-grade disease on presentation. More aggressive tumor characteristics in colon cancer patients with comorbid IBD fit the findings in earlier literature, while slightly better outcomes in IBD patients are an uncommon finding. This incongruence may potentially be explained by regular surveillance in patients with IBD, which may provide a protective effect through early detection of cancers. Differences with earlier reports in outcomes and staging could potentially be related to universal healthcare in our state, facilitating comprehensive IBD follow-up at our center. These findings suggest that under adequate and regular follow up, IBD patients are not necessarily inherently worse off when diagnosed with colon cancer.

1. Colon Cancer Patients with Inflammatory
Bowel Disease Do Not Necessarily Have
Worse Outcomes
Ramzi Amri, MD1,2
Liliana G Bordeianou, MD, MPH1,2
Patricia Sylla, MD1,2
and
David L Berger, MD 1,2
1
Massachusetts General Hospital, Division of General and Gastrointestinal Surgery.
2
Harvard Medical School, Department of Surgery.
Disclosures: none
02/03/15
10th
Annual Academic Surgical Congress, February 3-5 2015, Las Vegas, NV
07 - QuickShot: Clinical Research - Oncology

2. Introduction
• Inflammatory bowel disease (IBD) carries a high
risk of developing colon cancer.1
• Its relationship with the eventual outcomes is
less evident.
• Recent report2
confirmed early suspicions that
IBD may be associated with worse survival.3
• Other reports did not identify differences.4
• We therefore reviewed characteristics of IBD-
associated colon cancer in our population.
1. Triantafillidis JK, et al. Anticancer Res. 2009;29(7):2727–2737
2. Adams SV, et al. World J Gastroenterol. 2013;19(21):3241–3248.
3. Richards ME, et al. Ann Surg. 1989 Jun;209(6):764-73.
4. Delaunoit T, et al. Clin Gastroenterol Hepatol. 2006 Mar;4(3):335-42.

3. Methods
• Included:
• Surgical colon cancer patients at MGH 2004-2011
(n=1071)
• Patients with IBD: 38 (3.5%)
• Crohn’s: 21 (2.0%), UC: 16 (1.5%), 1 mixed form
• Comparison:
• Baseline pathology
• Outcomes: survival, disease-free survival
• Statistical analysis
• Ordinal: χ2
, continuous: Mann Whitney U
• Multivariate: Cox regression

4. Results

5. Conclusions
• IBD patients who develop colon cancer appear to have relatively
better staging and outcomes.
• These differences were present despite significantly higher-grade
disease on presentation.
• More aggressive tumor characteristics in colon cancer patients with
comorbid IBD fit findings in earlier literature.
• Slightly better outcomes in IBD patients are an uncommon finding.
• This incongruence may be explained by surveillance in IBD patients.
 Protective effect through early detection of cancers?
 Findings suggest that under adequate and regular follow up, IBD
patients are not inherently worse off when diagnosed with colon
cancer.

6. Questions?

7. Questions?