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Adenocarcinoma below stapled ileoanal anastomosis after restorative proctocolectomy for ulcerative colitis

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Abstract

A case of adenocarcinoma arising in a 39-year-old patient after restorative proctocolectomy is reported. The patient underwent an ileal pouch-anal anastomosis with double-stapled technique for severe ulcerative colitis 18 years earlier, without evidence of associated neoplasm or dysplasia in operative specimen. After endoscopic diagnosis of adenocarcinoma, the patient was submitted to excision of the pouch and permanent ileostomy, followed by combined radiotherapy and chemotherapy. Pathology showed an AJCC stage III moderately differentiated mucinous adenocarcinoma. The patient died 24 months after the operation, due to cancer progression. There are 50 reported cases in the indexed medical literature of carcinoma arisen after ileal pouch-anal anastomosis for ulcerative colitis. Twenty-five out of these arose after mucosectomy and hand-sewn anastomosis, and 25 after stapling technique. Furthermore, in 48% of the patients, dysplasia or cancer was already present at the time of the colectomy. The increase of reported cases suggests a routine long-term endoscopic surveillance in patients with long-standing ileal pouches, especially in presence of dysplasia or cancer in the proctocolectomy specimen.

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References

  1. Parks AG, Nicholls RJ (1978) Proctocolectomy without ileostomy for ulcerative colitis. BMJ 2:85–88

    Article  PubMed  CAS  Google Scholar 

  2. Schluender SJ, Mei L, Yang H, Fleshner PR (2006) Can a meta-analysis answer the question: is mucosectomy and handsewn or double stapled anastomosis better in ileal pouch anal anastomosis? Am Surg 72:912–916

    PubMed  Google Scholar 

  3. Branco BC, Sachar DB, Heimann TM et al (2009) Adenocarcinoma complicating restorative proctocolectomy for ulcerative colitis with mucosectomy performed by Cavitron Ultrasonic Surgical Aspirator. Colorectal Dis 11:428–429

    Article  PubMed  CAS  Google Scholar 

  4. Candioli S, Manigrasso A, Arcieri S et al (2007) Adenocarcinoma following restorative proctocolectomy for ulcerative colitis: a case report and review of the literature. G Chir 28:371–376

    PubMed  CAS  Google Scholar 

  5. Das P, Johnson MW, Tekkis PP, Nicholls RJ (2007) Risk of dysplasia and adenocarcinoma following restorative proctocolectomy for ulcerative colitis. Colorectal Dis 9:15–27

    Article  PubMed  CAS  Google Scholar 

  6. Ruffolo C, Scarpa M, Polese L, Angriman I (2007) Adenocarcinoma after restorative proctocolectomy for cancer in ulcerative colitis. Int J Colorectal Dis 22:1557–1558

    Article  PubMed  Google Scholar 

  7. Koh PK, Doumit J, Downs-Kelly E et al (2008) Ileo-anal J-pouch cancer: an unusual case in an unusual location. Tech Coloproctol 12:341–345

    Article  PubMed  CAS  Google Scholar 

  8. Panier-Suffat L, Marracino M, Resegotti A et al (2009) Anal transitional zone adenocarcinoma following restorative proctocolectomy for ulcerative colitis: case report and review of literature. Acta Gastroenterol Belg 72:441–443

    PubMed  CAS  Google Scholar 

  9. Ault GT, Nunoo-Mensah JW, Johnson L et al (2009) Adenocarcinoma arising in the middle of ileoanal pouches: report of five cases. Dis Colon Rectum 53:538–541

    Article  Google Scholar 

  10. Kariv R, Remzi FH, Lian L (2010) Preoperative colorectal neoplasia increases risk for pouch neoplasia in patients with restorative proctocolectomy. Gastroenterology 139:806–812

    Article  PubMed  Google Scholar 

  11. Um JW, M’Koma AE (2011) Pouch related dysplasia and adenocarcinoma following restorative proctocolectomy for ulcerative colitis. Tech Coloproctol 15:7–16

    Article  PubMed  CAS  Google Scholar 

  12. Zmora O, Spector D, Dotan I, Klausner JM, Rabau M, Tulchinsky H (2009) Is stapled ileal pouch anal anastomosis a safe option in ulcerative colitis patients with dysplasia or cancer? Int J Colorectal Dis 24:1181–1186

    Article  PubMed  CAS  Google Scholar 

  13. Rodriguez-Sanjuan LC, Polavvieja MG, Naranjo A, Castillo J (1995) Adenocarcinoma in an ileal pouch for ulcerative colitis. Dis Colon Rectum 38:779–780

    Article  PubMed  CAS  Google Scholar 

  14. Iwama T, Kamikawa J, Higuchi T et al (2000) Development of invasive adenocarcinoma in a long standing diverted ileal j-pouch for ulcerative colitis: report of a case. Dis Colon Rectum 43:101–104

    Article  PubMed  CAS  Google Scholar 

  15. Pedersen ME, Rahr HB, Fenger C, Qvist N (2008) Adenocarcinoma arising from the rectal stump eleven years after excision of an ileal J-pouch in a patient with ulcerative colitis: report of a case. Dis Colon Rectum 51:1146–1148

    Article  PubMed  Google Scholar 

  16. Walker M, Radley S (2006) Adenocarcinoma in an ileoanal pouch formed for ulcerative colitis in a patient with primary sclerosing cholangitis and a liver transplant: report of a case and review of the literature. Dis Colon Rectum 49:909–912

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, General and Oncologic Surgery Unit, San Camillo-Forlanini Hospitals, C.ne Gianicolense 86, 00152, Rome, Italy

    Luciano Alessandroni, Massimo Capaldi, Ilaria Guadagni, Andrea Scotti & Roberto Tersigni

  2. Gastroenterology Unit, San Camillo-Forlanini Hospitals, Rome, Italy

    Anna Kohn

Authors
  1. Luciano Alessandroni
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  2. Anna Kohn
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  3. Massimo Capaldi
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  4. Ilaria Guadagni
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  5. Andrea Scotti
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  6. Roberto Tersigni
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Correspondence to Luciano Alessandroni.

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Alessandroni, L., Kohn, A., Capaldi, M. et al. Adenocarcinoma below stapled ileoanal anastomosis after restorative proctocolectomy for ulcerative colitis. Updates Surg 64, 149–152 (2012). https://doi.org/10.1007/s13304-011-0089-0

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  • DOI: https://doi.org/10.1007/s13304-011-0089-0

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