Surgical resections of ulcerative colitis associated with dysplasia or carcinoma

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• 作者：Shinichi Sameshima (1)
  Shinichiro Koketsu (1)
  Emiko Takeshita (1)
  Yawara Kubota (1)
  Takashi Okuyama (1)
  Kazuyuki Saito (1)
  Yoshihiko Ueda (2)
  Toshio Sawada (3)
  Masatoshi Oya (1)
  
  1. Department of Surgery ; Dokkyo Medical University Koshigaya Hospital ; 2-1-50 ; Minami Koshigaya ; Koshigaya ; Saitama ; 343-8555 ; Japan
  2. Department of Pathology ; Dokkyo Medical University Koshigaya Hospital ; 2-1-50 ; Minami Koshigaya ; Koshigaya ; Saitama ; 343-8555 ; Japan
  3. Department of Medical Examination ; Shiba Park Clinic ; 2-4-1 Shibakouen ; Minato-ku ; Tokyo ; 105-0011 ; Japan
  
• 关键词：Ulcerative colitis ; Dysplasia ; Carcinoma ; Laparoscopic ; HALS ; IPACA ; IPAA ; Surveillance
• 刊名：World Journal of Surgical Oncology
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：13
• 期：1
• 全文大小：364 KB
• 参考文献：1. Jess, T, Rungoe, C, Peyrin-Biroulet, L (2012) Risk of colorectal cancer in patients with ulcerative colitis: a meta-analysis of population-based cohort studies. Clin Gastroenterol Hepatol 10: pp. 639-45 CrossRef
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  12. Matsuoka, H, Ikeuchi, H, Uchino, M, Bando, T, Takesue, Y, Nishigami, T (2013) Clinicopathological features of ulcerative colitis-associated colorectal cancer pointing to efficiency of surveillance colonoscopy in a large retrospective Japanese cohort. Int J Colorectal Dis 28: pp. 829-34 CrossRef
  13. Watanabe, T, Konishi, T, Kishimoto, J, Kotake, K, Muto, T, Sugihara, K (2011) Ulcerative colitis-associated colorectal cancer shows a poorer survival than sporadic colorectal cancer: a nationwide Japanese study. Inflamm Bowel Dis 17: pp. 802-8 CrossRef
  
• 刊物主题：Surgical Oncology;
• 出版者：BioMed Central
• ISSN：1477-7819

文摘

Background Ulcerative colitis (UC) patients have an increased risk of colorectal dysplasia and carcinoma. The purpose of this study was to analyze the clinical features and surgical treatment of ulcerative colitis associated with dysplasia or carcinoma. Methods We operated on 41 UC patients since April 2000. Twelve of the cases were associated with dysplasia or carcinoma. Ten patients were male and two were female; the median age was 58.0 years, and the average duration of disease was 19.2 years. Nine cases were pancolitis type and three were left-sided type. Six cases were remission-relapsing type and six were chronic inflammation type. In 10 of 12 cases, dysplasia or carcinoma was diagnosed before the operations. Nine cases were primary operations and two were second-time operations. Results Among ten patients who underwent primary operations, four patients had open surgery and six patients had hand-assisted laparoscopic surgery (HALS). Seven patients received anus/anal sphincter-preserving operations with reconstruction by the ileal pouch technique. Ileal pouch anal-canal anastomosis (IPACA) was performed in five cases and ileal pouch anal anastomosis (IPAA) in two cases. Abdomino-peritoneal resection was performed in two cases, proctcolectomy with permanent ileostomy in one case, and right hemicolectomy in one case. A 39-year-old patient was unresectable due to dissemination of the carcinoma. A 55-year-old patient who underwent IPACA showed night soiling postoperatively. Other patients who received IPAA and IPACA showed favorable anal function postoperatively. Histological examination showed low-grade dysplasia in two cases, high-grade dysplasia in three cases, and adenocarcinoma in seven cases. In the seven cases of adenocarcinoma, four, two, and one cases were stage 1, 3, and 4 according to TNM classification. Three of five cases with dysplasia were detected by surveillance colonoscopy. All patients with carcinoma were symptomatic and did not undergo surveillance colonoscopy. Conclusions IPACA by HALS was safely performed as an anal-preserving operation in UC patients with dysplasia or carcinoma. Non-anal-preserving operations for aged patients showed a preferable postoperative course. Surveillance colonoscopy is essential for detecting dysplasia before the development of carcinoma.