TITLE

THE RISK OF DYSPLASIA IN POST-SURGICAL COLORECTAL MUCOSA IN ULCERATIVE COLITIS

AUTHOR(S)
Rutter, M.D.; Saunders, B.P.
PUB. DATE
April 2003
SOURCE
Gut;Apr2003 Supplement 1, Vol. 52, pA95
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background and Aim: Although panproctocolectomy (PPC) is the operation of choice in longstanding extensive ulcerative colitis (UC), other procedures are occasionally chosen, leaving the patient at risk of dysplasia/cancer in the colorectal remnant. We aimed to assess this risk. Methods: Operative details of all patients in a major UC surveillance programme were reviewed. All patients undergoing surgery other than PPC were studied. Follow up data were obtained from our prospective surveillance database, case notes, colonoscopy and histology reports, GPs, other hospitals, and the Office of National Statistics. Details included indication For surgery, surgical procedure, and post-surgical outcome. Results: Twenty-one patients were studied (11 male, 10 female). Mean post-surgical follow-up was 6.3 years. Median age at operation was 50 (range 28-80). Median duration of colitis was 21 years (range 9-52). Indication For surgery was dysplasia (3), cancer (7), and symptomatic colitis/bleeding (11; surgical specimen showing cancer in 1, dysplasia in 2, and no dysplasia in 8). Nine patients had colectomy with ileostomy, 8 patients colectomy with ileorectal anastomosis, and 4 had segmental resection of neoplasia. Eleven patients remained well with no dysplasia. Four underwent surgical resection of the rectal remnant due to symptoms, no dysplasia being found. Six patients died: one from metastatic progression of initial Dukes' C cancer, and 5 from unrelated causes, one of whom had had post-operative rectal high grade dysplasia but had refused further surgery. This solitary patient with post-operative dysplasia had originally undergone ileorectal anastomosis for high grade dysplasia in the sigmold, but had also had rectal high grade dysplasia 2 years previously. Conclusion: Patients with ulcerative colitis who retain part of the colorectum post-operatively remain at risk of cancer; however this study suggests the risk is Iow, even in patients with previous colorectal neoplasia.
ACCESSION #
9747928

 

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