Long‐term cancer risk of the anorectal cuff following restorative proctocolectomy assessed by p53 expression and cuff dysplasia

Abstract

The lack of carcinoma and dysplasia in the columnar cuff epithelium specimens is reassuring. The lack of stabilized p53 and absence of a relationship between p53 stabilization and dysplasia up to 12 years after pouch formation suggests neoplastic transformation is a rare event. Furthermore, p53 expression was not useful in surveillance of cuff biopsies from patients who have undergone RP for UC and the search should continue for alternative predysplastic markers. These data suggest that in patients who do not have high-grade dysplasia or colorectal cancer at the time of RP, cuff surveillance in the first decade after pouch formation is unnecessary. However, we consider regular cuff surveillance biopsies should continue for patients with high-grade dysplasia, whether or not there was a carcinoma in the original colectomy specimen.

Surveillance for Dysplasia in Patients with Ileal Pouch-Anal Anastomosis for Ulcerative Colitis: An Interim Analysis

“…They state that DNA labeling index, overexpression of p53, and aneuploidy determination have better sensitivity. On the other hand, a recent long-term follow-up study of dysplasia in patients with IPAA for UC found p53 overexpression to be a nonspecific marker of malignancy [19]. Therefore, histopathology remains the gold standard for dysplasia and malignancy surveillance in patients with IPAA for UC, at least until cost-effective alternative or complementary immunohistochemical or biomarkers are available.…”

Incidence and Risk Factors of Cancer in the Anal Transitional Zone and Ileal Pouch following Surgery for Ulcerative Colitis and Familial Adenomatous Polyposis

“…Controversy surrounds the role of p53. Coull et al found no correlation between ATZ dysplasia and overexpression of p53 (affecting one in two patients) [159]. On the contrary, other studies have highlighted a link between over-expressed p53 and aneuploidy, dysplasia and pouch cancer [160,161].…”

Ileal Pouch Morphology and Microbiology in Ulcerative Colitis Patients

“…It is commonly believed that a history of colorectal cancer, the presence of "backwash ileitis" and the co-existence of primary sclerosing cholangitis are significant independent risk factors for malignant transformation in the "neorectum" [24]. Some authors suggest that a malignancy developing in an intestinal pouch may in fact be cancer of ileal-anal anastomosis originating from the remaining "cuff" of rectal mucosa [28,29]. Jiang et al describe the features of 12 cases of pouch and peripouch adenocarcinoma, and there was just 1 in the pouch only; 8 in the anal transitional zone (ATZ, defined as the part of the rectum between the dentate line and anastomosis); 2 in the ATZ and pouch; and 1 in a nonspecific peripouch region [26] In the present study, in addition to the clinical, endoscopic and histological evaluation of intestinal pouches, a microbiological assessment of material collected from pouch lumen was performed.…”