Background and Aims Crohn’s Disease increases colorectal cancer risk, with high prevalence of synchronous and metachronous cancers. Current guidelines for colorectal cancer in Crohn’s Disease recommend pan-proctocolectomy. Aim of this study was to evaluate oncologic outcomes of a less invasive surgical approach. Methods Retrospective database analysis of Crohn’s disease patients with colorectal cancer undergoing surgery at selected European and U.S. tertiary centres. Outcomes of segmental colectomy were compared with those of extended colectomy: total colectomy and pan-proctocolectomy. Primary outcome was progression-free survival. Secondary outcomes included overall survival, synchronous and metachronous colorectal cancer and major postoperative complications. Results Ninety-nine patients were included: 66 patients underwent segmental colectomy and 33 extended colectomy. Segmental colectomy patients were older (p= 0.0429), had less extensive colitis (p = 0.0002) and no pre-operatively identified synchronous lesions (p = 0.0109). Median follow up was 43 (31-62) months. There was no difference in unadjusted progression-free survival (p = 0.2570) nor in overall survival (p = 0.4191) between segmental and extended colectomy. Multivariate analysis adjusting for age, sex, ASA score and AJCC staging, confirmed no difference for progression-free survival (HR 1.00 p = 0.9993) or overall survival (HR 0.77 p = 0.6654). Synchronous and metachronous cancers incidence was 9% and 1.5% respectively. Perioperative mortality was nil and major complications were comparable (7.58% vs 6.06% p = 0.9998). Conclusions Segmental colectomy seems to offer similar long-term outcomes to more extensive surgery. Incidence of synchronous and metachronous cancers appears much lower than previously described. Further prospective studies are warranted to confirm these results.

Killian-Jamieson diverticulum (KJD) is a rare presentation of esophageal diverticulum. It is located beneath the cricopharyngeal muscle and arises laterally from the Killian-Jamieson space. The pathogenesis is postulated to be from increased intraluminal pressure. Most patients with KJD are typically asymptomatic; however, a common clinical presentation is dysphagia. Demographics of patients with KJD are typically elderly, in which the majority are female and over 50 years old. Due to less frequent diagnosis of KJD, there are a limited number of case studies compared to Zenker's diverticulum, the more common presentation of esophageal diverticulum. In this case study, we discuss an atypical case presentation in a young, African-American female.

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Background There is a recognized increased risk for colorectal cancer (CRC) in patients with Crohn’s disease (CD). CD patients with CRC might also show a higher prevalence of synchronous and metachronous cancers. On this basis, current guidelines recommend pan-proctocolectomy (PPC) as a treatment. Aim of this study was to evaluate oncologic outcomes and the actual risk of developing metachronous cancers in CD patients undergoing segmental colectomy (SC) for CRC. Methods All CRC CD patients undergoing surgery in select European and U.S. tertiary referral centres were enrolled. Short and long-term results of SC were compared with those of patients undergoing extended colectomies: total colectomy (TC) and panproctocolectomy (PPC). Primary outcomes were progression-free survival (PFS) and overall survival (OS). Secondary outcomes were postoperative complications, 30 days mortality, re-admission, length of stay, incidence of synchronous and metachronous lesions. Results 91 patients were included: 50 (54%) did not have Crohn’s colitis or had cancer developed in a non-involved segment; cancer developed in inflamed colic segment in 41 (46%). Patients without colitis were more often treated with SC (84%). 62 patients underwent segmental colectomies and 29 extended colectomies (EC): 19 PPC and 10 TC. Patients in the SC group were older (p 0.0429), harboured more metastases at diagnosis (p 0.0219) and were less likely to suffer from CD pancolitis (p 0.0022). Incidence of major complications was comparable in SC (8.6%) vs EC (3.45%) (p 0.06602). There was no perioperative mortality and no difference in specific complications, re-admission or length of stay. 28 patients (30%) suffered disease progression: 22 (35%) after SC and 6 (21%) after EC. Of the 19 cancer related deaths (20%), 16 (25%) were in SC and 3 (10%) in EC groups. There was no difference in unadjusted PFS between SC and EC (0.64 vs 0.79 respectively, Wilcoxon p 0.1029) nor in OS (0.74 vs 0.89, Wilcoxon p 0.1591), after a median follow up of 42 months (55.76 vs 31.13 months respectively). Multivariate analysis confirmed no difference in PFS (HR 1.582, p 0.4964) or OS (HR1 428, p 0.4758). 6 synchronous lesions were found in the 29 patients undergoing EC: 3 low grade dysplasia (10%), 1 high grade dysplasia (3.4%) and 2 preoperatively diagnosed cancers (6.8%). 1 patient (1,61%) developed a metachronous colon cancer of the 62 who had SC and none of the 10 TC. Conclusion CRC in CD is a complex situation and choice of procedure is multifaceted. Incidence of synchronous and metachronous cancers appears much lower than previously described. SC offers similar long-term outcomes to more extensive surgery. Current guidelines for the treatment of CRC in CD patients may need to be reconsidered.