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Ulcerative colitis and coexisting colorectal cancer: Recurrence rate after restorative proctocolectomy

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Abstract

Background: The association between mucosal ulcerative colitis (MUC) and adenocarcinoma is well established.

Methods: Records of patients who had undergone restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) from 1983 through 1992 were examined. Of these, 604 had MUC and 27 (4.3%) had MUC with coexisting cancer. Patients were surveyed annually for recurrent disease. Pouch function and quality of life were evaluated with a questionnaire and physical examination.

Results: The duration of disease was longer (p=0.001) in patients with cancer (16.1±8.0 years) than in those without cancer (9.1±7.1 years), although the mean age at diagnosis of MUC was the same. Of the 27 patients, 20 had colon cancer and seven had rectal cancer. Multicentricity was found in seven (25.9%) patients. Using the TNM staging classification, 14 patients (51.8%) had stage 1 cancer, eight (29.6%) had stage 2, four (14.8%) had stage 3, and one (3.8%) had stage 4. The patient with stage 4 cancer died 5 months after surgery and was excluded from the follow-up analysis. During a mean follow-up time of 4.3±2.6 years, cancer recurred in two of the remaining 26 patients (7.7%). In one patient, a local recurrence was found 8 months after surgery, and distant metastases were found in the other patient 35 months after surgery. Both recurrences were in patients with colon cancer. Two of the 26 patients died; one death was related to cancer recurrence (3.8%). Pouch function is good to excellent in all surviving patients.

Conclusions: Restorative proctocolectomy for patients with MUC and coexisting colorectal cancer can be performed with a favorable prognosis and function. It is appropriate for curative intent, given that an adequate margin without tumor is obtained.

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Authors and Affiliations

  1. Department of Colorectal Surgery, A-111, The Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195, Cleveland, OH, USA

    Yehiel Ziv MD,  Victor W. Fazio MD, Scott A. Strong MD, John R. Oakley MD, Jeffrey W. Milsom MD & Ian C. Lavery MD

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  1. Yehiel Ziv MD
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  2. Victor W. Fazio MD
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  3. Scott A. Strong MD
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  4. John R. Oakley MD
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  5. Jeffrey W. Milsom MD
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  6. Ian C. Lavery MD
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Ziv, Y., Fazio, V.W., Strong, S.A. et al. Ulcerative colitis and coexisting colorectal cancer: Recurrence rate after restorative proctocolectomy. Annals of Surgical Oncology 1, 512–515 (1994). https://doi.org/10.1007/BF02303617

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  • DOI: https://doi.org/10.1007/BF02303617

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