The functional success rate of the ileoanal reservoir procedure for ulcerative colitis is quite high. Despite the few early and late complications described there is now widespread acceptance of this procedure in the management of ulcerative colitis. We report a patient who developed an adenocarcinoma in the rectal cuff four years after having a pelvic pouch procedure. This new late complication brings to light several points including the importance of a radical total mucosectomy. The purpose of this paper is to discuss concern as to whether or not this procedure is indicated in colitis patients in whom severe dysplasia is the primary indication for surgery. Abdominal colectomy, rectal mucosectomy and ileoanal pouch anastomosis has gained increased acceptance as an alternative to total proctocolectomy and end ileostomy in the management of ulcerative colitis. A concern about this procedure is the fate of any islets of rectal mucosa left behind or regenerated in the cuff of rectal muscle stripped of its mucosa. The literature suggests that residual islets of mucosa appear in up to 20% of these procedures.' Regeneration of islets, however, does not seem to occur.2 This concern is particularly relevant in patients in whom the indication for surgery is severe dysplasia.3The increased risk of developing colonic carcinoma in patients with ulcerative colitis has been known for many years, especially in younger age groups who have had more extensive colitis for longer than 20 years.45 Cancer in colitis is frequently a fatal illness whch is entirely preventable by a total colectomy.3 A recent report suggests that a pelvic pouch is indicated even in the presence of colonic cancer providing that the cancer does not invade the pelvic floor muscles and the resection margins do not damage the sphincter mechanism.6Case report We report the first patient to have undergone a total colectomy, rectal mucosectomy and ileoanal pelvic pouch anastomosis, who subsequently developed a cancer in the residual rectal cuff. This 59 year old man was diagnosed as having ulcerative colitis at age 21. He was well for 28 years until 1977 when he was found to have

IMPORTANCE Several compounds found in coffee possess antioxidant, anti-inflammatory, and insulin-sensitizing effects, which may contribute to anticancer activity. Epidemiological studies have identified associations between increased coffee consumption and decreased recurrence and mortality of colorectal cancer. The association between coffee consumption and survival in patients with advanced or metastatic colorectal cancer is unknown.OBJECTIVE To evaluate the association of coffee consumption with disease progression and death in patients with advanced or metastatic colorectal cancer. DESIGN, SETTING, AND PARTICIPANTSThis prospective observational cohort study included 1171 patients with previously untreated locally advanced or metastatic colorectal cancer who were enrolled in Cancer and Leukemia Group B (Alliance)/SWOG 80405, a completed phase 3 clinical trial comparing the addition of cetuximab and/or bevacizumab to standard chemotherapy. Patients reported dietary intake using a semiquantitative food frequency questionnaire at the time of enrollment.

Background: Hyperinsulinemia is considered to be important in the development of colon cancer, but few studies have investigated the associations of hyperinsulinemia with colon cancer survival via dietary scores.Methods: Empirical dietary index for hyperinsulinemia (EDIH) was derived to assess the insulinemic potential of daily diets reflecting the long-term insulin exposure, with higher (more positive) scores indicating higher insulinemic diets. We prospectively estimated the HRs and 95% confidence intervals (CI) to investigate the association of EDIH with disease-free, recurrence-free, and overall survival among patients with stage III colon cancer (1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009) enrolled in a randomized adjuvant chemotherapy trial (CALGB 89803).Results: Of 1,024 patients (median follow-up: 7.3 years), 311 died, 350 had recurrences, and 394 had events for disease-free survival. Compared with patients in the lowest quintile of EDIH, the corresponding HRs of patients in the highest quintile for diseasefree survival events, cancer recurrence, and overall mortality were 0.80 (95% CI, 0.56-1.15), 0.76 (95% CI, 0.51-1.11), and 0.77 (95% CI, 0.52-1.14).Conclusions: Higher EDIH was not associated with the risk of colon cancer recurrence or mortality in this population of patients with stage III colon cancer.Impact: EDIH, as a measure of dietary insulinemic potential, may be associated with colon cancer risk but not survival in patients with late-stage colon cancer.

Background In nonmetastatic colorectal cancer, overweight and mild-to-moderately obese patients experience improved outcomes compared with other patients. Obesity’s influence on advanced or metastatic colorectal cancer (mCRC) is relatively unexplored. Methods We conducted a prospective body mass index (BMI) companion study in Cancer and Leukemia Group B (now Alliance)/SWOG 80405, a phase III metastatic colorectal cancer (mCRC) treatment trial. BMI was measured at trial registration. Primary and secondary endpoints were overall and progression-free survival, respectively. To minimize confounding by poor and rapidly declining health, we used Cox proportional hazards regression to adjust for known prognostic factors, comorbidities, physical activity, and weight loss during the 6 months prior to study entry. We also examined weight loss prior to enrollment as an independent predictor of patient outcome. All statistical tests were two-sided. Results Among 2323 patients with mCRC, there were no statistically significant associations between BMI and overall or progression-free survival (adjusted Ptrend = .12 and .40, respectively). Weight loss during the 6 months prior to study entry was associated with shorter overall and progression-free survival; compared with individuals with stable weight ±4.9%, individuals with weight loss greater than 15% experienced an adjusted hazard ratio of 1.52 for all-cause mortality (95% confidence interval [CI] = 1.26 to 1.84; Ptrend < .001) and of 1.23 for disease progression or death (95% CI = 1.02 to 1.47; Ptrend = .006). Conclusions In this prospective study of patients with mCRC, BMI at time of first-line chemotherapy initiation was not associated with patient outcome. Weight loss prior to study entry was associated with increased risk of patient mortality and disease progression.

Background Energy balance-related biomarkers are associated with risk and prognosis of various malignancies. Their relationship to survival in metastatic colorectal cancer (mCRC) requires further study. Methods Baseline plasma insulin-like growth factor (IGF)-I, IGF-binding protein (IGFBP)-3, IGFBP-7, C-peptide, and adiponectin were measured at time of trial registration in a prospective cohort of patients with mCRC participating in a National Cancer Institute-sponsored trial of first-line systemic therapy. We used Cox proportional hazards regression to adjust for confounders and examine associations of each biomarker with overall (OS) and progression-free survival (PFS). P values are two-sided. Results Median follow-up for 1,086 patients was 6.2 years. Compared to patients in the lowest IGFBP-3 quintile, patients in the highest IGFBP-3 quintile experienced an adjusted hazard ratio (HR) for OS of 0.57 (95% confidence interval [CI] = 0.42 to 0.78, Pnon-linearity < .001) and for PFS of 0.61 (95% CI = 0.45 to 0.82, Ptrend = .003). Compared to patients in the lowest IGFBP-7 quintile, patients in the highest IGFBP-7 quintile experienced an adjusted HR for OS of 1.60 (95% CI = 1.30 to 1.97, Ptrend < .001) and for PFS of 1.38 (95% CI = 1.13 to 1.69, Ptrend = < .001). Plasma C-peptide and IGF-I were not associated with patient outcomes. Adiponectin was not associated with OS; there was a non-linear U-shaped association between adiponectin and PFS (Pnon-linearity = .03). Conclusions Among patients with mCRC, high plasma IGFBP-3 and low IGFBP-7 were associated with longer OS and PFS. Extreme levels of adiponectin were associated with shorter PFS. These findings suggest potential avenues for prognostic and therapeutic innovation.