Detection of Anorectal Cancer among Patients with Crohn's Disease Undergoing Surveillance with Various Biopsy Methods

Matsuo, Hiroshi; Mizushima, Tsunekazu; Nezu, Riichiro; Nakajima, Kiyokazu; Takahashi, Hidekazu; Haraguchi, Naotsugu; Nishimura, Junichi; Hata, Taishi; Yamamoto, Hirofumi; Doki, Yuichiro; Mori, Masaki

doi:10.1159/000446799

Cited by 4 publications

(4 citation statements)

References 30 publications

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“…reported 24/64 (37%) right‐sided colon cancer cases and 40/64 (63%) left‐sided CRC cases. From the total review of 17 studies with 107 cases from Asia, we identified 90/107 (84.1%) patients with left‐sided CRC and 17/107 (15.9%) patients with right‐sided colonic cancer 15,25–40 . The locations of cancer in patients with CD were significantly different among countries ( P < 0.01).…”

Section: Resultsmentioning

confidence: 99%

“…The characteristics of 52 studies reporting data from 208 patients with ARC are shown in Table 2 11,15,19,23,25,28,30,34,36–80 . Although many reports did not describe the details of each characteristic, the median survival prognosis was 2.1 ± 2.3 years in 74 patients, and advanced cancer greater than stage T3 occurred in 46/74 (62.1%) patients.…”

Section: Resultsmentioning

confidence: 99%

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Intestinal cancer in patients with Crohn's disease: A systematic review and meta‐analysis

Uchino

Ikeuchi

Hata

et al. 2020

J of Gastro and Hepatol

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Background and Aim Although surveillance colonoscopy is recommended by several guidelines for Crohn's disease (CD), the evidence is insufficient to support the validity of this recommendation. Moreover, the efficacy of surveillance colonoscopy for anorectal cancer remains unclear. Therefore, we performed a systematic review of cancer in patients with CD before considering the proper surveillance methods. Methods We conducted a systematic review and meta‐analysis examining the incidence of intestinal cancer and a literature review to clarify the characteristic features of cancer in CD. We performed the systematic literature review of studies published up to May 2019. Results Overall, 7344 patients were included in eight studies. The standardized incidence ratios (95% confidence intervals) of colorectal cancer (CRC) and small bowel cancer (SBC) were 2.08 (1.43–3.02) and 22.01 (9.10–53.25), respectively. The prevalence of CRC and SBC was 57/7344 (0.77%) and 17/7344 (0.23%), respectively, during a median follow‐up of 12.55 years. Additionally, 54 studies reporting 208 anorectal cancer cases were identified. In patients with anorectal cancer, the prognosis for survival was 2.1 ± 2.3 years, and advanced cancer greater than stage T3 occurred in 46/74 patients (62.1%). Many more reports of anorectal cancer were published in Asia than in Western countries. Conclusion Although we were unable to state a recommendation for surveillance for SBC, we should perform cancer surveillance for CRC in patients with CD. However, the characteristics of cancer may differ according to geography or race. We must establish proper and effective surveillance methods that are independently suitable to detect these differences.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Intestinal cancer in patients with Crohn's disease: A systematic review and meta‐analysis

Uchino

Ikeuchi

Hata

et al. 2020

J of Gastro and Hepatol

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“…A recent meta-analysis also showed a significantly worse prognosis with CD-CRC, but most studies have not included populations in Asia (6,24,25). In Western countries, CD-CRC tends to be more left-sided, similar to the findings in Asia, but the incidence of right-sided tumor is higher than the incidence of sporadic CRC (6,8,(26)(27)(28)(29). In this study, 81.5% of CD-CRC cases were located in the anorectum, similar to other reports from Asia (21,22).…”

Section: Discussionmentioning

confidence: 90%

Crohn's Disease–Associated Anorectal Cancer Has a Poor Prognosis With High Local Recurrence: A Subanalysis of the Nationwide Japanese Study

et al. 2023

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on behalf of the Study Group for Inflammatory Bowel Disease Associated Intestinal Cancers by the Japanese Society for Cancer of the Colon and Rectum INTRODUCTION: Colorectal cancer (CRC) is one of the major life-threatening complications in patients with Crohn's disease (CD). Previous studies of CD-associated CRC (CD-CRC) have involved only small numbers of patients, and no large series have been reported from Asia. The aim of this study was to clarify the prognosis and clinicopathological features of CD-CRC compared with sporadic CRC. METHODS:A large nationwide database was used to identify patients with CD-CRC (n 5 233) and sporadic CRC (n 5 129,783) over a 40-year period, from 1980 to 2020. Five-year overall survival (OS), recurrence-free survival (RFS), and clinicopathological characteristics were investigated. The prognosis of CD-CRC was further evaluated in groups divided by colon cancer and anorectal cancer (RC). Multivariable Cox regression analysis was used to adjust for confounding by unbalanced covariables.

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“…In all of these cases, the disease duration was > 10 years, and abdominoperineal resection (APR) and total pelvic exenteration (TPE) were performed in most cases. Cancer surveillance revealed that the total detection rate of CRC was 6.19%, and the detection rate was 1.85% with core needle biopsy, 5.56% with endoscopic biopsy, and 5.88% with excisional biopsy [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Crohn’s disease-related anal fistula cancer diagnosed by examination under anesthesia: a case report

Kaneshiro,

Sanechika,

Kishi

et al. 2023

surg case rep

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Background As the number of patients with inflammatory bowel disease (IBD) increases, the incidence of IBD-related colorectal cancer (CRC) is also on the rise. Crohn’s disease (CD)-related CRC has been reported to have a poorer prognosis than sporadic CRC, and the early detection of CD-related CRC is difficult. Japanese patients with CD are reported to have a higher frequency of anorectal cancer than the Western population; however, methods for early diagnosis have not yet been established because of perianal pain during the examination. Case presentation We report a case of CD-related anal fistula cancer that was detected early by surveillance examination under anesthesia (EUA). The patient was a 37-year-old man, diagnosed with CD at the age of 15 years and started medical treatment. However, due to poor disease control, the intestinal tract remained highly inflamed and the patient continued to have over 10 bowel movements per day. He was referred to our hospital for surgical treatment after a colonoscopy (CS), which revealed multiple active ulcers and stenoses. Since three perianal seton drainage tubes had been placed around his anus since the age of 33 years, we decided to perform an EUA to rule out cancer coexistence in the anorectal region. After a random biopsy of the rectum by CS under general anesthesia, we resected and curetted multiple perianal fistulas as much as possible and reinserted the seton drainage tubes. Pathological examination of the fistula tract revealed adenocarcinoma in one tract, indicating the coexistence of anal fistula cancer. Based on the diagnosis of multiple intestinal stenoses and anal fistula cancer due to CD, we performed hand-assisted laparoscopic total colectomy, rectal amputation, extensive perineal resection, and reconstruction using a left rectus abdominis flap. Conclusion In a long-term CD patient with anorectal lesions, we performed an EUA to diagnose the coexistence of anal fistula cancer at an early stage, and surgical resection was achieved. EUA is effective for the early detection and treatment of CD-related CRC and may contribute to an improved prognosis.

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Detection of Anorectal Cancer among Patients with Crohn's Disease Undergoing Surveillance with Various Biopsy Methods

Cited by 4 publications

References 30 publications

Intestinal cancer in patients with Crohn's disease: A systematic review and meta‐analysis

Intestinal cancer in patients with Crohn's disease: A systematic review and meta‐analysis

Crohn's Disease–Associated Anorectal Cancer Has a Poor Prognosis With High Local Recurrence: A Subanalysis of the Nationwide Japanese Study

Crohn’s disease-related anal fistula cancer diagnosed by examination under anesthesia: a case report

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