Preoperative Colorectal Neoplasia Increases Risk for Pouch Neoplasia in Patients With Restorative Proctocolectomy

Kariv, Revital; Remzi, Feza H.; Lian, Lei; Bennett, Ana E.; Kiran, Ravi P.; Kariv, Yehuda; Fazio, Victor W.; Lavery, Ian C.; Shen, Bo

doi:10.1053/j.gastro.2010.05.085

Cited by 177 publications

(188 citation statements)

References 44 publications

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“…A review of more than 1000 patients who underwent IPAA found no cases of malignancy near the pouch [27] whereas a more recent report of 1200 patients found an ATZ/pouch neoplasia incidence of 1.3 % [10]. A Cox model in a group of more than 3200 UC patients showed a cumulative incidence of ATZ/pouch cancer at 5, 10, 15, 20, and 25 years of 0.2, 0.4, 0.8, 2.4, and 3.4 %, respectively [28]. The pouch cancer rate in FAP although low is believed to be slightly higher than that in UC [29].…”

Section: Discussionmentioning

confidence: 85%

“…Less certain is the association between PSC and pouch cancer, as seen in our recent patient. A previous study in patients with UC and PSC who had an ileal pouch showed an increased risk of pouch neoplasia [33] (as well as pouchitis [34]) whereas another did not [28].…”

Section: Discussionmentioning

confidence: 94%

“…Another theory for cancer development in any cancer following IPAA is the inflammation-dysplasiacancer sequence similarly seen in colorectal cancers [31,36]. There is a concern that "backwash ileitis" [16,31] or chronic pouchitis [14,18] seen in many UC patients can initiate this cascade, although this has recently been disputed by some authors [10,28]. A third theory is of primary cancer recurrence [10], which seems unlikely, given the long interval seen in a number of these patients (mean 8.9 years after IPAA in our review).…”

Section: Discussionmentioning

confidence: 99%

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Adenocarcinoma of the ileal pouch mucosa: case report and literature review

O’Mahoney

Scherl

Lee

et al. 2014

Int J Colorectal Dis

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The risk of developing ileal pouch mucosa adenocarcinoma appears low. However, increasing reports of these cancers are concerning as most patients present with advanced disease after many years. Patients with a previous history of dysplasia/cancer may be at increased risk. We believe surveillance after IPAA should include the anal transition zone and the ileal pouch mucosa. The establishment of expert consensus guidelines on pouch surveillance should be considered in the near future.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

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Adenocarcinoma of the ileal pouch mucosa: case report and literature review

O’Mahoney

Scherl

Lee

et al. 2014

Int J Colorectal Dis

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“…However, the risk of development of cancer in the ileal pouch or at the anal anastomosis is still present and warrants regular surveillance. Reported incidences of neoplasia in all patients with the IPAA are approximately 1% at 5 years and up to 5% at 25 years, with higher rates in patients who have had previous resections for colonic cancer [45,46]. Most of these neoplastic events are found in the 1-2 cm strip of retained rectal mucosa at the pouch-anal anastomosis.…”

Section: Tpc and Ipaa Versus End Ileostomymentioning

confidence: 99%

The surgical treatment of inflammatory bowel disease-associated dysplasia

Connelly

Koltun²

2013

Expert Review of Gastroenterology & Hepatology

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“…Dysplasia has been associated with type C mucosa [123,124] and, in patients with refractory pouchitis [125], PSC [126] and preoperative colonic or rectal cancer or dysplasia [127]. However, the absolute number of cases of pouch dysplasia is small [128], with the incidence of pouch cancer even lower.…”

Section: The Problematic Pouchmentioning

confidence: 99%

Managing Intractable Proctitis and the Problematic Pouch

Kent

Keshav²

2014

Dig Dis

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Proctitis accounts for a significant proportion of cases of ulcerative colitis (UC), and some patients subsequently develop more extensive disease. However, most patients continue to have limited inflammation, although the changes in the distal colon and rectum can occasionally be severe, and symptoms of increased frequency, rectal bleeding and urgency can be as disabling as they are for patients with more extensive colitis. Furthermore, although symptoms are typically well controlled with standard medications, medically refractory proctitis poses particular problems. Patients generally are not systemically unwell, and there is no added fear of cancer. Therefore, the prospect of colectomy for such limited disease is resisted by patients, physicians and surgeons alike. Unusual therapies, often delivered locally by enema or suppository, have been tested in small case series without definitive outcomes. The pathogenesis of such limited, yet intractable inflammation remains unclear, and the differential diagnosis should be carefully reviewed to ensure that local disease, whether it is infectious, vascular, or a result of injury or degeneration, is not overlooked. Ileo-anal pouch formation is the surgery of choice for about 20% of patients with UC who undergo colectomy. In the majority of cases, this surgery results in an acceptable quality of life and freedom from a stoma. However, in a sizeable minority of cases, pouch dysfunction can cause intractable problems. The causes of pouch dysfunction are varied and must all be considered carefully, particularly in refractory cases. Pouchitis is a common issue and is usually transient and easily treated. However, refractory and chronic pouchitis can be challenging. Ischaemia, injury, infection and Crohn's disease can all cause refractory pouch dysfunction. In a minority of cases, there appears to be no apparent organic pathology, and the presumptive diagnosis is that of a functional pouch disorder. Although it is much rarer, neoplastic changes in the pouch must also be considered, and the risk managed appropriately. The management of both intractable proctitis and the problematic pouch is made more challenging by the wide differential diagnosis that must be considered and by the paucity of high-quality clinical trials to support any one therapy. Key strategies to overcoming these limitations include methodical and systematic investigation and review, and a willingness to tailor therapy to the individual patient. Clinical trials of new treatments should be supported, and data from the experience with small cohorts of patients should be meticulously collected, critically analysed and widely disseminated.

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Preoperative Colorectal Neoplasia Increases Risk for Pouch Neoplasia in Patients With Restorative Proctocolectomy

Cited by 177 publications

References 44 publications

Adenocarcinoma of the ileal pouch mucosa: case report and literature review

Adenocarcinoma of the ileal pouch mucosa: case report and literature review

The surgical treatment of inflammatory bowel disease-associated dysplasia

Managing Intractable Proctitis and the Problematic Pouch

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