eP614 - Crohn’s Disease-Associated Small Bowel Cancers

Purpose/Background: Small bowel (SB) cancer is a rare complication of small bowel Crohn's with a high mortality. Detecting it early is challenging because the symptoms mimic those of active Crohn's disease, including abdominal pain, nausea, vomiting, and weight loss. This study aims to provide insights into our institutional experience with Crohn's disease-associated small bowel cancers.Methods/Interventions: All patients with Crohn’s disease and small bowel cancer who underwent curative surgery at Mayo Clinic between 1992 and 2021 were included. Demographics, Crohn’s medications, tumor characteristics, postoperative outcomes, and disease-free recurrence and survival data were collected for each patient. Kaplan Meier curves were used to calculate 5-year overall survival (OS) and disease-free survival (DFS).Results/Outcomes: 64 patients (56% males) were included. The mean age at surgery was 54.1 (standard deviation [SD] 12.4) years and for Crohn's disease duration before cancer diagnosis was 18.2 ± 14.8 years. Fifty-five percent had a prior biological exposure at any time point, and it was most commonly infliximab (38%) followed by adalimumab (33%). Fifty percent had been exposed to immunomodulators. Fifty-nine percent received biologics within 12 weeks of surgery and 42% were on steroids within 4 weeks of surgery. The mean preoperative albumin was 3.2 g/dL (SD 0.7) and the mean preoperative CRP was 39.7 mg/L (SD 94.8). Stricturing was the most common Crohn’s disease phenotype (60%). Forty-four percent of patients had undergone prior gastrointestinal surgery. The operations were performed open in 63% of patients, and the two most common operations were segmental small bowel resection (47%) and ileocolic resection (47%).In 14% of cases, the patient did not have a diagnosis of Crohn’s disease preoperatively and CD and SB cancer were diagnosed simultaneously. The cancer was suspected based on preoperative imaging in 27% and on endoscopy in 22%. The predominant histology was adenocarcinoma (83%). The most common tumor location was in the ileum (50%). Most tumors were T3 (52%), 53% were lymph node-negative and 18% had distant metastases at diagnosis. There were no 30-day mortalities observed. However, 12% of patients required readmission, and 14% underwent reoperation within 30 days. 47% received adjuvant chemotherapy and 5% adjuvant radiotherapy. At 5 years, OS was 70 % and DFS was 58%.Conclusion/

Discussion: SB cancer is an infrequent complication of Crohn's disease. It is often diagnosed at an advanced stage, with many cases discovered intraoperatively. We show a favorable 5-year overall survival rate with aggressive surgery and adjuvant therapies.Kaplan Meier curves showing 5-year overall survival (OS) and disease-free survival (DFS).