Low Incidence of Dysplasia and Colorectal Cancer Observed among Inflammatory Bowel Disease Patients with Prolonged Colonic Diversion

Bettner, Weston; Rizzo, Anthony; Brant, Steven R.; Dudley-Brown, Sharon; Efron, Jonathan E.; Fang, Sandy H.; Gearhart, Susan L.; Marohn, Michael R.; Parian, Alyssa; Pezhouh, Maryam Kherad; Melia, Joanna; Safar, Bashar; Truta, Brindusa; Wick, Elizabeth C.; Lazarev, Mark

doi:10.1093/ibd/izx102

Cited by 7 publications

(27 citation statements)

References 33 publications

(56 reference statements)

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“…Besides, the following conditions have been reported as characteristics of CD-associated CRC: patients were approximately 10 years younger than those with typical CRC, had a long duration of CD (10-20 years), in many cases, cancer developed in the right colon, the histologic type was mucinous adenocarcinoma, and cancer was likely to develop in lesions caused by CD [15][16][17]. Bettner et al reported that while the risk of CRC in in ammatory bowel disease (IBD) populations have been well described, there is a lack of data on the risk of CRC in diverted IBD bowel segments [1]. We believe that our cases can be included in this category.…”

Section: Discussionmentioning

confidence: 99%

“…We believe that our cases can be included in this category. Few studies focusing on diverted CRC have been published, and based on these reports, only a small percentage of cases have been identi ed [1,[18][19][20][21][22]. These are summarized in Table 4.…”

Section: Discussionmentioning

confidence: 99%

“…If surveillance colonoscopy is negative for dysplasia or cancer, an examination is recommended every 1-2 years after that [24]. Currently, there are no consensus guidelines to inform surveillance endoscopy of diverted segments [1]. The insertion of an endoscope was impossible due to the stricture of the diverted large intestine, except for one patient diagnosed at stage I. Pelvic magnetic resonance imaging and EUA are performed in patients who are not colonoscopy candidates due to stricture.…”

Section: Discussionmentioning

confidence: 99%

“…Crohn's disease (CD)-related anorectal cancer following fecal diversion is a rare disease. Although the risk of colorectal cancer (CRC) has been well described, the risk of CRC in diverted bowel segments is lacking, and the current risk remains unclear [1]. Typically, CDassociated cancers present in advanced stages are poorly differentiated and have a worse prognosis than usual adenocarcinoma [2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

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Clinicopathological and prognostic evaluations of anorectal cancer after fecal diversion for patients with Crohn's disease

Kuroki

Sugita

Koganei

et al. 2021

Preprint

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Purpose: Colorectum diversion with a proximal stoma is often the preferred surgical approach in patients with Crohn's disease-related anorectal lesions or refractory colitis. To date, few studies have assessed the incidence and prognosis of cancer in the diverted anorectal segments. This study aimed to evaluate the clinical characteristics and prognosis of anorectal cancer associated with Crohn's disease following fecal diversion.Methods: This was a retrospective study based on medical records of patients diagnosed with Crohn's disease between 1999 and 2020. It was conducted at Yokohama Municipal Citizen's Hospital. Patients diagnosed with anorectal cancer following fecal diversion were identified, and their prognosis was the primary outcome measure.Results: Among 1,615 patients, 232 patients (14%) underwent colorectum diversion. Of those 232 patients, 12 were diagnosed with anorectal cancer following fecal diversion, nine were diagnosed with advanced cancer, 10 underwent abdominoperineal resection, and eight died. The overall five-year survival rate in patients diagnosed with anorectal cancer following fecal diversion was 20%. Conclusion: Crohn's disease-associated anorectal cancer following fecal diversion was challenging to diagnose early, and patients had a poor prognosis even after curative resection. Early abdominoperineal resection may be considered for patients with Crohn's disease who cannot benefit from cancer screening and surveillance due to difficulty accessing the anorectal stricture via endoscopy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Clinicopathological and prognostic evaluations of anorectal cancer after fecal diversion for patients with Crohn's disease

Kuroki

Sugita

Koganei

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…Crohn's disease (CD)-related anorectal cancer following fecal diversion is a rare disease. Although the risk of colorectal cancer (CRC) has been well described, the risk of CRC in diverted bowel segments is lacking, and the current risk remains unclear [ 1 ]. Typically, CD-associated cancers present in advanced stages are poorly differentiated and have a worse prognosis than usual adenocarcinoma [ 2 – 5 ].…”

Section: Introductionmentioning

confidence: 99%

Clinicopathological and prognostic evaluations of anorectal cancer after fecal diversion for patients with Crohn’s disease

et al. 2021

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Purpose Colorectum diversion with a proximal stoma is often the preferred surgical approach in patients with Crohn's disease-related anorectal lesions or refractory colitis. To date, few studies have assessed the incidence and prognosis of cancer in the diverted anorectal segments. This study aimed to evaluate the clinical characteristics and prognosis of anorectal cancer associated with Crohn's disease following fecal diversion. Methods This was a retrospective study based on medical records of patients diagnosed with Crohn’s disease between 1999 and 2020. It was conducted at Yokohama Municipal Citizen’s Hospital. Patients diagnosed with anorectal cancer following fecal diversion were identified, and their prognosis was the primary outcome measure. Results Among 1615 patients, 232 patients (14%) underwent colorectum diversion. Of those 232 patients, 11 were diagnosed with anorectal cancer following fecal diversion, ten were diagnosed with advanced cancer, 10 underwent abdominoperineal resection, and eight died. 1 could not undergo resection due to multiple lung metastasis and died. The overall five-year survival rate in patients diagnosed with anorectal cancer following fecal diversion was 20%. Conclusion Crohn's disease-associated anorectal cancer following fecal diversion was challenging to diagnose early, and patients had a poor prognosis even after curative resection. Early abdominoperineal resection may be considered for patients with Crohn's disease who cannot benefit from cancer screening and surveillance due to difficulty accessing the anorectal stricture via endoscopy.

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Diversion proctocolitis and the problem of the forgotten rectum in inflammatory bowel diseases: A systematic review

et al. 2021

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Background and aims: Diversion proctocolitis (DP) is a non-specific mucosal inflammation arising in the defunctionalized colon and/or rectum following faecal diversion (colostomy, ileostomy). Differential diagnosis of DP from the underlying disease in patients with inflammatory bowel diseases (IBD) is often unclear. As a result, it might be difficult to undertake any specific treatment. We aimed to systematically review the literature evidence on DP in IBD patients.Methods: For this qualitative systematic review, we searched PubMed, EMBASE and Scopus to identify all studies published until July 2021 including IBD patients affected by DP.Results: Overall, 37 papers published between 1982 and 2021 were included. A total of 1.211 IBD patients were included: 613 UC (50.6%), 524 CD (43.3%), 66 IBDunclassified (IBD-U) (5.4%), 8 unspecified patients (0.7%). Most patients with DP are asymptomatic, although inflammation is detectable in almost all patients with a rectal stump. Reduced short-chain fatty acids and an altered microbiome, may trigger mucosal inflammation and have been proposed as causing factors. An increased risk of developing cancer on DP has been reported in patients with a history of previous dysplasia/cancer. Conclusions:The etiopathogenesis of DP is still unknown. The efficacy of mesalamine, corticosteroids or short-chain fatty acids has not been proven by randomized trials yet. Since the incidence of cancer of the rectal stump can reach 4.5 per 1.000 diverted patients-year, IBD patients undergoing subtotal colectomy with end-ileostomy should undergo close endoscopic surveillance, being eventually counseled for surgery with or without the restoration of the intestinal continuity.

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Low Incidence of Dysplasia and Colorectal Cancer Observed among Inflammatory Bowel Disease Patients with Prolonged Colonic Diversion

Abstract: Diverted dysplasia occurred infrequently with rates overlapping those reported in registries for IBD-based rectal cancers. Neoplasia was undetected in patients with < 10 pyd, regardless of diversion duration, suggesting low yield for endoscopic surveillance before this time.

Cited by 7 publications

References 33 publications

Clinicopathological and prognostic evaluations of anorectal cancer after fecal diversion for patients with Crohn's disease

Clinicopathological and prognostic evaluations of anorectal cancer after fecal diversion for patients with Crohn's disease

Clinicopathological and prognostic evaluations of anorectal cancer after fecal diversion for patients with Crohn’s disease

Diversion proctocolitis and the problem of the forgotten rectum in inflammatory bowel diseases: A systematic review

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