Abstract
Background: Presence of dysplasia or cancer at the anal transition zone (ATZ) is considered an indication to pouch excision with permanent ileostomy, while redo ileal pouch anal anastomosis (IPAA) is contraindicated. These recommendations are however based on anecdotal evidence due to the rarity of this occurrence. Methods: We retrospectively analyzed our prospectively collected database on redo IPAA. Among patients who underwent redo IPAA between 1988 and 2020, those whose primary indication was dysplasia/cancer in the ATZ were included in this study. Results: Out of 542 total patients, 8 patients underwent redo IPAA for either dysplasia or cancer at the ATZ. Of the 8 patients who underwent redo IPAA for dysplasia/cancer, 5 had ulcerative colitis, 2 had familial adenomatous polyposis (FAP), and one had hereditary non-polypoid colon cancer. Preoperative pathology of ATZ showed adenocarcinoma in 2 cases, low grade dysplasia in 3 and high grade dysplasia in 3. Final pathology was consistent with preoperative biopsy in 6 cases, while 2 cases of preoperative dysplasia showed no evidence of dysplasia at final pathology. The 2 cases of cancer were, respectively, a pT4N0 and a pT1N0 rectal cancer. The patient with pT4N0 adenocarcinoma had an early recurrence 4 months after redo IPAA with peritoneal carcinomatosis and pelvic lymph nodal metastases. She died 23 months after redo IPAA of cancer-related causes. The remaining 7 patients had no recurrence and are alive at a median follow up of 77 months (range 27–144). Pouch failure occurred in only one case due to severe pouch dysfunction with incontinence and poor quality of life requiring permanent diversion 38 months after redo IPAA. Conclusion(s): Redo ileal pouch anal anastomosis appears to be an acceptable option with good long-term outcomes in case of dysplasia or cancer at the anal transition zone.
Published Version
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