Abstract
PurposeColorectum diversion with a proximal stoma is often the preferred surgical approach in patients with Crohn's disease-related anorectal lesions or refractory colitis. To date, few studies have assessed the incidence and prognosis of cancer in the diverted anorectal segments. This study aimed to evaluate the clinical characteristics and prognosis of anorectal cancer associated with Crohn's disease following fecal diversion.MethodsThis was a retrospective study based on medical records of patients diagnosed with Crohn’s disease between 1999 and 2020. It was conducted at Yokohama Municipal Citizen’s Hospital. Patients diagnosed with anorectal cancer following fecal diversion were identified, and their prognosis was the primary outcome measure.ResultsAmong 1615 patients, 232 patients (14%) underwent colorectum diversion. Of those 232 patients, 11 were diagnosed with anorectal cancer following fecal diversion, ten were diagnosed with advanced cancer, 10 underwent abdominoperineal resection, and eight died. 1 could not undergo resection due to multiple lung metastasis and died. The overall five-year survival rate in patients diagnosed with anorectal cancer following fecal diversion was 20%.ConclusionCrohn's disease-associated anorectal cancer following fecal diversion was challenging to diagnose early, and patients had a poor prognosis even after curative resection. Early abdominoperineal resection may be considered for patients with Crohn's disease who cannot benefit from cancer screening and surveillance due to difficulty accessing the anorectal stricture via endoscopy.
Highlights
Crohn’s disease (CD)-related anorectal cancer following fecal diversion is a rare disease
When a stoma is created for severe anorectal lesions or when refractory colitis or anal proctitis is diverted in CD patients, inflammatory stricture occurs in the diseased lesion
Of the 11 patients, 10 underwent abdominoperineal resection (APR) and diverted anorectal cancer (ARC) was pathologically diagnosed in the original surgical specimen and one patient could not be operated because the tumor was unresectable with multiple lung metastasis
Summary
Crohn’s disease (CD)-related anorectal cancer following fecal diversion is a rare disease. When a stoma is created for severe anorectal lesions or when refractory colitis or anal proctitis is diverted in CD patients, inflammatory stricture occurs in the diseased lesion. This inflammatory stricture makes it challenging to investigate the diverted anorectum using endoscopy. If cancer develops in the excluded part of the anorectum, it is usually diagnosed at a more advanced stage than usual CD-related anorectal cancer (ARC), resulting in a poor outcome.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
