Abstract
Patients with ulcerative colitis (UC) are at risk of developing a colorectal cancer. The aim of this study was to examine our experience in the treatment of ulcerative Colitis Cancer (CC), the role of the ileal pouch–anal anastomosis (IPAA), and the clinical outcome of the operated patients. Data from 417 patients operated on for ulcerative colitis were reviewed. Fifty-two (12%) were found to have carcinoma of the colon (n = 43) or the rectum (n = 9). The indication to surgery, the histopathological type, the cancer stage, the type of surgery, the oncologic outcome, and the functional result of IPAA were examined. The majority of the patients had a mucinous or signet-ring carcinoma. An advanced stage (III or IV) was present in 28% of the patients. Early (stage I or II) CC was found in all except one patient submitted to surgery for high-grade dysplasia, low-grade dysplasia, or refractory colitis. Thirty-nine (75%) of the 52 patients underwent IPAA, 10 patients were treated with a total abdominal proctocolectomy with terminal ileostomy. IPAA was possible in 6/9 rectal CC. Cumulative survival rate 5 and 10 years after surgery was 61% and 53%, respectively. The survival rate was significantly lower for mucinous or signet-ring carcinomas than for other adenocarcinoma. No significant differences of the functional results and quality of life were observed between IPAA patients aged less than or more than 65 years. Failure of the pouch occurred in 5 of 39 (12.8%) patients for cancer of the pouch (2 pts) or for tumoral recurrence at the pelvic or peritoneal level. Early surgery must be considered every time dysplasia is discovered in patients affected by UC. The advanced tumoral stage and the mucous or signet-ring hystotype influence negatively the response to therapy and the survival after surgery. IPAA can be proposed in the majority of the patients with a functional result similar to that of UC patients not affected by CC. Failures of IPAA for peritoneal recurrence or metachronous cancer of the pouch can be observed when CC is advanced, moucinous, localized in the distal rectum, or is associated with primary sclerosing cholangitis.
Highlights
Chronic inflammation of the colorectal mucosa, as is typically found in ulcerative colitis (UC), is an ascertained risk factor for the onset of colorectal cancer (CRC)
One of these patients had previously undergone to total colectomy and ileo-rectal anastomosis (IRA) and had developed rectal cancer
Surgery must be considered when dysplasia is discovered in patients affected by UC
Summary
Chronic inflammation of the colorectal mucosa, as is typically found in ulcerative colitis (UC), is an ascertained risk factor for the onset of colorectal cancer (CRC). The development of colorectal neoplasia in patients affected by UC is related to several factors: duration of UC, extent of colonic involvement, chronically active colitis from childhood, severity of the first attack, primary sclerosing cholangitis (PSC), and family history of CRC [1–4]. The progression from inflammation to CRC is a multistep process in which the accumulation of genetic mutations leads to sequential mucosal modifications, gradually moving to low-grade dysplasia (LGD), to high-grade dysplasia (HGD), and to cancer. The dysplastic or early neoplastic lesions arising in the colonic mucosa affected
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