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. 2021 May 13;13(10):2350.
doi: 10.3390/cancers13102350.

Management of Low Rectal Cancer Complicating Ulcerative Colitis: Proposal of a Treatment Algorithm

Bruno Sensi  1 , Giulia Bagaglini  1 , Vittoria Bellato  1 , Daniele Cerbo  1 , Andrea Martina Guida  1 , Jim Khan  2 , Yves Panis  3 , Luca Savino  4 , Leandro Siragusa  1 , Giuseppe S Sica  1
Affiliations

Management of Low Rectal Cancer Complicating Ulcerative Colitis: Proposal of a Treatment Algorithm

Bruno Sensi et al. Cancers (Basel). .

Abstract

Low rectal Carcinoma arising at the background of Ulcerative Colitis poses significant management challenges to the clinicians. The complex decision-making requires discussion at the multidisciplinary team meeting. The published literature is scarce, and there are significant variations in the management of such patients. We reviewed treatment protocols and operative strategies; with the aim of providing a practical framework for the management of low rectal cancer complicating UC. A practical treatment algorithm is proposed.

Keywords: inflammatory bowel diseases; rectal cancer; surgical management; treatment algorithm; ulcerative colitis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram for assessment of studies identified by the search strategy.
Figure 2
Figure 2
Functional outcomes of IPAA for rectal cancer in ulcerative colitis.
Figure 3
Figure 3
Histologic features of early T1 colorectal carcinoma. (A) At low power (Haematoxylin and Eosin, original magnification 10×), the picture shows a malignant sessile polyp. The polypectomy margin is free from neoplasia. At high power (H&E, original magnification 40×), isolated and neoplastic glands invade the upper third of the submucosa (sm1 according to the Kikuchi classification). (B) Smooth muscle actin immunohistochemistry stain; (C) confirms the presence of glands exceeding the muscolaris mucosae.
Figure 4
Figure 4
Local excision combined with stapled ileal pouch-anal anastomosis. (A) Schematic representation of low rectal cancer, less than 2 cm from the dentate line. (B) Residual rectum with local excision scar after first stage surgery. (C) Stapled IPAA on the residual rectal cuff at the level of the previous excision.
Figure 5
Figure 5
Treatment algorithm for patients with ulcerative colitis and rectal cancer >2 cm from the pectinate line.
Figure 6
Figure 6
Treatment algorithm for patients with ulcerative colitis and rectal cancer < 2 cm from the pectinate line.
See this image and copyright information in PMC

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