Prevalence of Advanced Colorectal Neoplasm After Kidney Transplantation: Surveillance Based on the Results of Screening Colonoscopy

Kwon, Jee Hye; Koh, Seong‐Joon; Kim, Ji Yeon; Kim, Ji Won; Lee, Kook Lae; Kim, Byeong Gwan; Im, Jong Pil; Kim, Sang Woo

doi:10.1007/s10620-015-3525-z

Cited by 16 publications

(11 citation statements)

References 26 publications

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“…As the taking of immunosuppressants progresses, death with functioning graft, which causes death due to cardiovascular disease, malignancy, or other conditions while the transplanted kidney remains functional, can be a problem rather than loss of the transplanted kidney due to rejection [18]. The risk of developing colorectal cancer during immunosuppressant therapy is reported to be 2 to 5 times higher than that when immunosuppressants are not taken [19]. Recently, the number of colorectal cancer operations has been increasing in Japan [20], and in the future, the number of patients with colorectal cancer who are taking immunosuppressants is expected to increase.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic two-stage operation for rectal cancer with refractory obstructive colitis after kidney transplantation: a case report

Fujinaga¹,

Akagi²,

Etoh³

et al. 2020

surg case rep

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Background: Although obstructive colitis with colon cancer is not a rare disease, most cases can be improved with conservative therapy. We report a case of a patient who underwent a laparoscopic two-stage operation for rectal cancer with refractory obstructive colitis after kidney transplantation. Case presentation: The patient was a 71-year-old man taking immunosuppressants who had previously undergone right living kidney transplantation for chronic nephritis. He presented to hospital complaining of abdominal pain and was diagnosed as having rectal cancer with obstructive colitis. Although conservative therapy by fasting was continued for 5 weeks, his obstructive colitis did not improve. Therefore, we decided to perform a two-stage operation. First, we performed a laparoscopic Hartmann's operation. It took 6 months for his obstructive colitis to improve after this operation, and then we performed a laparoscopic colorectal anastomosis. There were no postoperative complications in either operation. Conclusion: A laparoscopic two-stage operation could be one of the operative options to reduce postoperative complications in patients with comorbidities such as taking immunosuppressants.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic two-stage operation for rectal cancer with refractory obstructive colitis after kidney transplantation: a case report

Fujinaga¹,

Akagi²,

Etoh³

et al. 2020

surg case rep

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“…The increased risk of CRC after kidney transplantation has been well documented. [ 10 – 12 ] Moreover, compared with the general population, CRC that are diagnosed in kidney transplant patients often display a more aggressive behavior, and the aggressive behavior is characterized by an earlier age of cancer diagnosis, [ 13 ] a more advanced cancer stage (American joint committee on cancer stage > II), [ 14 ] and a lower 5-year survival. [ 13 , 15 ] Interestingly, a significantly reduced risk of rectal cancer was observed in the transplant recipients when separated from colon cancer, [ 16 , 17 ] and it seems that the elevated risk of CRC was driven by excess of proximal colon cancer.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic assisted low anterior resection for advanced rectal cancer in a kidney transplant recipient

Xia

Chen²,

Yao³

et al. 2016

Medicine

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Introduction:Development of de novo malignancy has become a major cause of late mortality in solid organ transplant recipients. Surgery is currently the most important treatment of choice for transplant patients with resectable CRC. However, conventional open surgery represents a great risk to these high-risk patients. They seem to benefit more from laparoscopic surgery, based on the favorable oncological outcome and remarkable short-term advantages of this approach.Patient concerns:In this study, we have reported a case of a 50-year-old man who had underwent kidney transplantation for 4 years. He presented with recurrent hematochezia and frequent loose stools for 1 year, and consulted a doctor for recent progressive general malaise and weight loss.Diagnoses:Colonoscopy revealed a near-circumferential mass at the middle rectum about 8 cm from anal verge. Further biopsy confirmed a diagnosis of adenocarcinoma. Following computed tomography demonstrated peripheral lymph node metastasis, but no signs of distant metastasis.Interventions:The patient underwent a laparoscopic assisted low anterior resection with total mesorectal excision for rectal cancer. Concomitantly, a loop transverse colostomy was performed to prevent anastomotic leakage. The surgery was completed within 120 min with a blood loss of 100 mL, and immunosuppressive therapy was not stopped perioperatively. Considering the tumor stage of pT3N1M0, the patient also received adjuvant chemotherapy with a regimen of FOLFOX for 8 cycles.Outcomes:Anastomotic bleeding occurred in this patient about 4 h after surgery, and a control of hemorrhage per anus was performed timely. The following postoperative course was uneventful without any complications, and graft function stayed well. After 4 months of follow-up period, the patient was in a good condition. No evidences of local recurrence and distant metastasis were found.Conclusion:We have presented a case of successful laparoscopic resection for advanced rectal cancer in a kidney transplant recipient. We believe laparoscopic surgery for CRC in transplant recipients is technically feasible and oncologically safe, which could be a preferred option of surgical procedure in the near future.

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“…Surgical treatments and intensive chemotherapy are often limited by comorbidities and potential nephrotoxicity, and the efficacy of the treatment is limited by the chronic immunosuppression, which, in most cases, is not reduced for the fear of acute graft rejection and graft loss. In this setting, the clinical screening protocols may aid, in principle, to detect early stage diseases allowing for curative treatment, finally resulting in reduced cancer-related morbidity and mortality [9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

“…Colorectal cancer is the third most commonly diagnosed cancer worldwide [13], and survival in kidney transplant recipients may be worse than in the general population regardless of the stage of diagnosis [3,4,6]. There are many studies suggesting that the incidence of colorectal neoplasia, including advanced adenomas, is significantly higher after kidney transplantation [6,10,14]; however, the data are conflicting [3][4][5][6][7][8]. Screening with guaiac-based faecal occult blood tests (FOBT) or faecal immunochemical tests (FIT) followed by colonoscopy in people over the age of 50 with average risk has been shown to reduce the mortality of colorectal cancer in the general population [15][16][17][18][19].…”

Section: Introductionmentioning

confidence: 99%

Colorectal Cancer after Kidney Transplantation: A Screening Colonoscopy Case-Control Study

et al. 2021

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The incidence of colorectal cancer in kidney transplant recipients has been previously reported with conflicting results. In this study, we investigated if the incidence of colorectal advanced neoplasms in kidney transplant recipients, evaluated with screening colonoscopy, was higher than in healthy individuals. One-hundred sixty kidney transplant recipients undergoing screening colonoscopy were compared with 594 age- and sex-matched healthy individuals. Advanced colorectal neoplasia was found in 22 patients (13.7%), including four patients (2.5%) with colorectal cancer. Compared with the healthy population, kidney transplant recipients did not have an increased risk of developing a colorectal cancer (OR 0.69; 95% CI 0.236–2.063, p = 0.688) although it developed at a younger age. In contrast, kidney transplant recipients had a higher risk of developing an advanced adenoma compared with the control group (OR 1.65; 95% CI 0.930–2.981, p = 0.04). In conclusion, kidney transplant recipients did not have an increased incidence of colorectal cancer compared with healthy population. However, transplant patients displayed a higher incidence of colorectal adenomas, suggesting that screening colonoscopy in kidney transplant recipients should be expanded to include even younger recipients (<50 years old).

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Prevalence of Advanced Colorectal Neoplasm After Kidney Transplantation: Surveillance Based on the Results of Screening Colonoscopy

Abstract: Colonoscopy is recommended for patients before and after kidney TPL, especially for those 50 years of age or older. Colonoscopy surveillance after TPL is warranted strictly according to the baseline risk stratification.

Cited by 16 publications

References 26 publications

Laparoscopic two-stage operation for rectal cancer with refractory obstructive colitis after kidney transplantation: a case report

Laparoscopic two-stage operation for rectal cancer with refractory obstructive colitis after kidney transplantation: a case report

Laparoscopic assisted low anterior resection for advanced rectal cancer in a kidney transplant recipient

Colorectal Cancer after Kidney Transplantation: A Screening Colonoscopy Case-Control Study

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