Predictive Factors of Recurrence in Non-Operative Management of Right-Side Colonic Diverticulitis: Multicenter Retrospective Cohort Study
Khajohnsak Bhocksombud¹, Ekkarin Supatrakul², Kullawat Bhatanaprabhabhan¹, Boonchai Ngamsirimas¹, Nataphon Santrakul¹, Rangsima Thiengthiantham¹, Pawit Sutharat², Suwan Sanmee², Witcha Vipudhamorn², Punnawat Chandrachamnong¹
Affiliation : ¹ Colorectal Surgery Unit, Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand; ² Colorectal Surgery Unit, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Background: Non-operative management (NOM) is the primary treatment strategy for uncomplicated right-sided colonic diverticulitis (RCD). However, some patients experience recurrence after successful NOM.
Objective: To investigate the recurrence rate and predictive factors for RCD after successful NOM.
Materials and Methods: A retrospective review was conducted on medical records of patients diagnosed with uncomplicated RCD at Vajira Hospital and Maharaj Nakorn Chiang Mai Hospital between January 2017 and December 2022. Predictive factors for recurrence were analyzed using multivariable Cox regression, and recurrence-free survival was evaluated using Kaplan-Meier analysis.
Results: Ninety patients were diagnosed with uncomplicated RCD, of whom 87 (96.7%) achieved successful NOM. The mean follow-up duration was 56.42 months (SD 18.89). Twelve patients (13.8%) experienced recurrence, with a median recurrence time of 11.5 months (IQR 5.7 to 31.7). There were no significant differences in baseline characteristics between the patients with and without recurrence. Smoking was significantly associated with recurrence (HR 4.56, 95% CI 1.33 to 15.6, p=0.02), with smokers showing lower recurrence-free probabilities at 12, 24, and 60 months compared to non-smokers with 72.7% versus 92.2% at 60 months. Hepatic flexure diverticulitis was also a significant predictor of recurrence (HR 4.59, 95% CI 1.17 to 11.94, p=0.03).
Conclusion: In the two-centers study from Thailand, smoking and hepatic flexure involvement were significant predictive factors for recurrence in RCD after successful NOM. These findings highlight the need for close monitoring and tailored management strategies in high-risk patients, and future studies should incorporate larger, multi-center data to validate these results.
Received 10 March 2025 | Revised 28 May 2025 | Accepted 28 May 2025
DOI: 10.35755/jmedassocthai.2025.6.500-505-02894
Keywords : Right-side colonic diverticulitis; Predictive factors; Non-operative management
