Clinical features and oncologic outcomes in patients with rectal cancer and ulcerative colitis: A single-institution experience

Amit Merchea, Bruce G. Wolff, Eric Dozois, Zaid M. Abdelsattar, W. Scott Harmsen, David Larson

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

BACKGROUND: Patients with chronic ulcerative colitis are at increased risk of developing colorectal cancer. Limited data exists in ulcerative colitis patients with rectal cancer regarding clinical and oncologic outcomes, and the ideal operative approach. OBJECTIVE: To describe our experience in the management of patients with rectal cancer in the setting of chronic ulcerative colitis and their outcomes. DESIGN: This study is a retrospective review of all patients with ulcerative colitis who underwent a colorectal operation between 1990 and 2009. SETTINGS: This study was conducted at a tertiary care center. PATIENTS: Adult patients with rectal adenocarcinoma undergoing a colorectal operation for chronic ulcerative colitis were included in this study. Patients with colonic malignancy, indeterminate colitis, and Crohn's disease were excluded. MAIN OUTCOME MEASURES: Clinical features and longterm oncologic outcomes are described. RESULTS: Forty-one patients were identified; their mean age was 53.9 years. Mean duration of ulcerative colitis was 22.5 years. Thirty-four patients (83%) were known to have cancer preoperatively; in 7 patients it was discovered on postoperative pathology. Eight of the tumors were in the proximal rectum, 19 in the mid rectum, and 13 in the distal rectum. The most common operation performed was total proctocolectomy with end ileostomy (n = 21), followed by IPAA. The majority of patients (n = 28, 68%) had stage I or II disease. Estimates of overall survival at 1 and 5 years were 83% and 62%, and, for disease-free survival, the estimates were 93% and 62%. Local and distant recurrence was seen in 5 and 9 patients. Eighty-nine percent of the observed recurrences were in patients with stage III and IV disease. Pouch failure occurred in 2 patients. LIMITATIONS: This retrospective study was possibly underpowered, given the small sample sizes. CONCLUSION: In our cohort, rectal cancer in the setting of chronic ulcerative colitis was rare, often presented at an early stage, and was not always diagnosed preoperatively. The presence of early-stage rectal cancer should not be considered a contraindication for IPAA.

Original languageEnglish (US)
Pages (from-to)881-885
Number of pages5
JournalDiseases of the Colon and Rectum
Volume55
Issue number8
DOIs
StatePublished - Aug 2012

Fingerprint

Rectal Neoplasms
Ulcerative Colitis
Rectum
Recurrence
Neoplasms
Ileostomy
Colitis
Tertiary Care Centers
Crohn Disease
Sample Size
Disease-Free Survival
Colorectal Neoplasms
Adenocarcinoma
Retrospective Studies
Pathology

Keywords

  • Ileal pouch-anal anastomosis
  • Inflammatory bowel disease
  • Rectal cancer
  • Ulcerative colitis

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Clinical features and oncologic outcomes in patients with rectal cancer and ulcerative colitis : A single-institution experience. / Merchea, Amit; Wolff, Bruce G.; Dozois, Eric; Abdelsattar, Zaid M.; Harmsen, W. Scott; Larson, David.

In: Diseases of the Colon and Rectum, Vol. 55, No. 8, 08.2012, p. 881-885.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND: Patients with chronic ulcerative colitis are at increased risk of developing colorectal cancer. Limited data exists in ulcerative colitis patients with rectal cancer regarding clinical and oncologic outcomes, and the ideal operative approach. OBJECTIVE: To describe our experience in the management of patients with rectal cancer in the setting of chronic ulcerative colitis and their outcomes. DESIGN: This study is a retrospective review of all patients with ulcerative colitis who underwent a colorectal operation between 1990 and 2009. SETTINGS: This study was conducted at a tertiary care center. PATIENTS: Adult patients with rectal adenocarcinoma undergoing a colorectal operation for chronic ulcerative colitis were included in this study. Patients with colonic malignancy, indeterminate colitis, and Crohn's disease were excluded. MAIN OUTCOME MEASURES: Clinical features and longterm oncologic outcomes are described. RESULTS: Forty-one patients were identified; their mean age was 53.9 years. Mean duration of ulcerative colitis was 22.5 years. Thirty-four patients (83{\%}) were known to have cancer preoperatively; in 7 patients it was discovered on postoperative pathology. Eight of the tumors were in the proximal rectum, 19 in the mid rectum, and 13 in the distal rectum. The most common operation performed was total proctocolectomy with end ileostomy (n = 21), followed by IPAA. The majority of patients (n = 28, 68{\%}) had stage I or II disease. Estimates of overall survival at 1 and 5 years were 83{\%} and 62{\%}, and, for disease-free survival, the estimates were 93{\%} and 62{\%}. Local and distant recurrence was seen in 5 and 9 patients. Eighty-nine percent of the observed recurrences were in patients with stage III and IV disease. Pouch failure occurred in 2 patients. LIMITATIONS: This retrospective study was possibly underpowered, given the small sample sizes. CONCLUSION: In our cohort, rectal cancer in the setting of chronic ulcerative colitis was rare, often presented at an early stage, and was not always diagnosed preoperatively. The presence of early-stage rectal cancer should not be considered a contraindication for IPAA.",
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T2 - A single-institution experience

AU - Merchea, Amit

AU - Wolff, Bruce G.

AU - Dozois, Eric

AU - Abdelsattar, Zaid M.

AU - Harmsen, W. Scott

AU - Larson, David

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N2 - BACKGROUND: Patients with chronic ulcerative colitis are at increased risk of developing colorectal cancer. Limited data exists in ulcerative colitis patients with rectal cancer regarding clinical and oncologic outcomes, and the ideal operative approach. OBJECTIVE: To describe our experience in the management of patients with rectal cancer in the setting of chronic ulcerative colitis and their outcomes. DESIGN: This study is a retrospective review of all patients with ulcerative colitis who underwent a colorectal operation between 1990 and 2009. SETTINGS: This study was conducted at a tertiary care center. PATIENTS: Adult patients with rectal adenocarcinoma undergoing a colorectal operation for chronic ulcerative colitis were included in this study. Patients with colonic malignancy, indeterminate colitis, and Crohn's disease were excluded. MAIN OUTCOME MEASURES: Clinical features and longterm oncologic outcomes are described. RESULTS: Forty-one patients were identified; their mean age was 53.9 years. Mean duration of ulcerative colitis was 22.5 years. Thirty-four patients (83%) were known to have cancer preoperatively; in 7 patients it was discovered on postoperative pathology. Eight of the tumors were in the proximal rectum, 19 in the mid rectum, and 13 in the distal rectum. The most common operation performed was total proctocolectomy with end ileostomy (n = 21), followed by IPAA. The majority of patients (n = 28, 68%) had stage I or II disease. Estimates of overall survival at 1 and 5 years were 83% and 62%, and, for disease-free survival, the estimates were 93% and 62%. Local and distant recurrence was seen in 5 and 9 patients. Eighty-nine percent of the observed recurrences were in patients with stage III and IV disease. Pouch failure occurred in 2 patients. LIMITATIONS: This retrospective study was possibly underpowered, given the small sample sizes. CONCLUSION: In our cohort, rectal cancer in the setting of chronic ulcerative colitis was rare, often presented at an early stage, and was not always diagnosed preoperatively. The presence of early-stage rectal cancer should not be considered a contraindication for IPAA.

AB - BACKGROUND: Patients with chronic ulcerative colitis are at increased risk of developing colorectal cancer. Limited data exists in ulcerative colitis patients with rectal cancer regarding clinical and oncologic outcomes, and the ideal operative approach. OBJECTIVE: To describe our experience in the management of patients with rectal cancer in the setting of chronic ulcerative colitis and their outcomes. DESIGN: This study is a retrospective review of all patients with ulcerative colitis who underwent a colorectal operation between 1990 and 2009. SETTINGS: This study was conducted at a tertiary care center. PATIENTS: Adult patients with rectal adenocarcinoma undergoing a colorectal operation for chronic ulcerative colitis were included in this study. Patients with colonic malignancy, indeterminate colitis, and Crohn's disease were excluded. MAIN OUTCOME MEASURES: Clinical features and longterm oncologic outcomes are described. RESULTS: Forty-one patients were identified; their mean age was 53.9 years. Mean duration of ulcerative colitis was 22.5 years. Thirty-four patients (83%) were known to have cancer preoperatively; in 7 patients it was discovered on postoperative pathology. Eight of the tumors were in the proximal rectum, 19 in the mid rectum, and 13 in the distal rectum. The most common operation performed was total proctocolectomy with end ileostomy (n = 21), followed by IPAA. The majority of patients (n = 28, 68%) had stage I or II disease. Estimates of overall survival at 1 and 5 years were 83% and 62%, and, for disease-free survival, the estimates were 93% and 62%. Local and distant recurrence was seen in 5 and 9 patients. Eighty-nine percent of the observed recurrences were in patients with stage III and IV disease. Pouch failure occurred in 2 patients. LIMITATIONS: This retrospective study was possibly underpowered, given the small sample sizes. CONCLUSION: In our cohort, rectal cancer in the setting of chronic ulcerative colitis was rare, often presented at an early stage, and was not always diagnosed preoperatively. The presence of early-stage rectal cancer should not be considered a contraindication for IPAA.

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