Surgical procedure for sporadic colorectal cancer in patients with mild ulcerative colitis

Abstract

Restorative proctocolectomy is recognized as the standard procedure for colitic cancer in patients with ulcerative colitis (UC). However, whether this represents the optimal procedure for UC patients with sporadic cancer remains questionable, as functional quality of life differs substantially between patients with proctocolectomy and partial resection. This study considered possible problems associated with sporadic cancer in UC. Case 1 is a 55-year-old man with a 3-year history of UC who was treated with endoscopic resection for sporadic adenocarcinoma in the rectum. Low anterior resection was subsequently performed due to deep invasion. The final diagnosis was pT3. Differentiating between histopathological diagnoses of sporadic and colitic cancer was difficult. Case 2 is a 71-year-old woman with a 6-year history of UC who was diagnosed with type 1 sporadic sigmoid colon cancer. Dementia and umbilical hernia were present as complications. Total colectomy was performed in consideration of the coexisting complications. Although partial resection for sporadic cancer could be favorable in mild colitis, further immunosuppressive treatments have the potential to elevate the risk of recurrence for advanced cancer. Restorative proctocolectomy may be safer to avoid further recurrent colitis and cancer except in elderly patients or those with other complications.

Keywords: Colitic cancer; Partial resection; Restorative proctocolectomy; Sporadic cancer; Ulcerative colitis.

Fig. 1

Endoscopic findings for case 1. Colonoscopic study revealed rectal cancer. A lateral-spreading tumor with clear borders, slightly central depression and a diameter of about 10 mm was apparent in the upper rectum on colonoscopy (←). The colonic mucosa around the tumor showed mildly inflamed erosion without disappearance of vascular network patterns compatible with mild UC (↓).

Fig. 2

Histopathological findings for endoscopic resection. Histopathological examination for the endoscopically resected specimen with hematoxylin and eosin staining (×20) revealed malignant cells which were apparent in the vertical margins with invasion into the deeper submucosal layer.

Fig. 3

Histopathological findings for the resected specimen. a Histopathological findings for the resected specimen with hematoxylin and eosin staining (×40) after LAR revealed deep invasion to the subserosal layer (↑). b Positive immunohistostaining with anti-p53 antibody (×40) was recognized in the whole part of invasive tumor (arrowhead) with negative staining in crypts around the tumor (↓).

Fig. 4

Endoscopic findings for case 2. Type 1 tumor (arrowhead) with mild erosion and inconspicuous inflammation in the surrounding mucosa was revealed at the sigmoid colon on colonoscopy.