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Review
. 2022 Jan 21;14(3):530.
doi: 10.3390/cancers14030530.

Incidence and Risk Factors of Cancer in the Anal Transitional Zone and Ileal Pouch following Surgery for Ulcerative Colitis and Familial Adenomatous Polyposis

Guillaume Le Cosquer  1 , Etienne Buscail  2   3 , Cyrielle Gilletta  1 , Céline Deraison  3 , Jean-Pierre Duffas  2 , Barbara Bournet  1 , Géraud Tuyeras  2 , Nathalie Vergnolle  3 , Louis Buscail  1   4
Affiliations
Review

Incidence and Risk Factors of Cancer in the Anal Transitional Zone and Ileal Pouch following Surgery for Ulcerative Colitis and Familial Adenomatous Polyposis

Guillaume Le Cosquer et al. Cancers (Basel). .

Abstract

Proctocolectomy with ileal pouch-anal anastomosis is the intervention of choice for ulcerative colitis and familial adenomatous polyposis requiring surgery. One of the long-term complications is pouch cancer, having a poor prognosis. The risk of high-grade dysplasia and cancer in the anal transitional zone and ileal pouch after 20 years is estimated to be 2 to 4.5% and 3 to 10% in ulcerative colitis and familial polyposis, respectively. The risk factors for ulcerative colitis are the presence of pre-operative dysplasia or cancer, disease duration > 10 years and severe villous atrophy. For familial polyposis, the risk factors are the number of pre-operative polyps > 1000, surgery with stapled anastomosis and the duration of follow-up. In the case of ulcerative colitis, a pouchoscopy should be performed annually if one of the following is present: dysplasia and cancer at surgery, primary sclerosing cholangitis, villous atrophy and active pouchitis (every 5 years without any of these factors). In the case of familial polyposis, endoscopy is recommended every year including chromoendoscopy. Even if anal transitional zone and ileal pouch cancers seldom occur following proctectomy for ulcerative colitis and familial adenomatous polyposis, the high mortality rate associated with this complication warrants endoscopic monitoring.

Keywords: anal transitional zone cancer; familial adenomatous polyposis; high grade dysplasia; ileal pouch; ulcerative colitis.

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Conflict of interest statement

The authors have no conflict of interest to declare.

Figures

Figure 1
Figure 1
(a) Hand-sewn ileal pouch anal anastomosis with transanal mucosectomy. The dotted line represents the mucosectomy started above the dentate line; (b) Double-stapled ileal pouch anal anastomosis 1–2 cm above the dentate line. The blue hatched area represents the cuff rectal mucosa.
Figure 2
Figure 2
Endoscopic monitoring guidelines after restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) according the International Ileal Pouch Consortium [167,168].
Figure 3
Figure 3
Proposed therapeutic algorithm for lesion detected on the ileal pouch-anal anastomosis (IPAA).
Figure 4
Figure 4
Main risk factors, frequency and putative underlying mechanisms of high-grade dysplasia and cancer in the anal transitional zone and ileal pouch following restorative coloproctectomy for ulcerative colitis and familial adenomatous polyposis.
Figure 5
Figure 5
Endoscopic monitoring according to European Society of Gastrointestinal Endoscopy (ESGE) guidelines. * Depending on patient tolerance.
See this image and copyright information in PMC

References

    1. McLaughlin S.D., Clark S.K., Tekkis P.P., Ciclitira P.J., Nicholls R.J. Review Article: Restorative Proctocolectomy, Indications, Management of Complications and Follow-up—A Guide for Gastroenterologists. Aliment. Pharm. 2008;27:895–909. doi: 10.1111/j.1365-2036.2008.03643.x. - DOI - PubMed
    1. Ungaro R., Mehandru S., Allen P.B., Peyrin-Biroulet L., Colombel J.-F. Ulcerative Colitis. Lancet. 2017;389:1756–1770. doi: 10.1016/S0140-6736(16)32126-2. - DOI - PMC - PubMed
    1. Ordás I., Eckmann L., Talamini M., Baumgart D.C., Sandborn W.J. Ulcerative Colitis. Lancet. 2012;380:1606–1619. doi: 10.1016/S0140-6736(12)60150-0. - DOI - PubMed
    1. Frolkis A.D., Dykeman J., Negrón M.E., Debruyn J., Jette N., Fiest K.M., Frolkis T., Barkema H.W., Rioux K.P., Panaccione R., et al. Risk of Surgery for Inflammatory Bowel Diseases Has Decreased over Time: A Systematic Review and Meta-Analysis of Population-Based Studies. Gastroenterology. 2013;145:996–1006. doi: 10.1053/j.gastro.2013.07.041. - DOI - PubMed
    1. Magro F., Gionchetti P., Eliakim R., Ardizzone S., Armuzzi A., Barreiro-de Acosta M., Burisch J., Gecse K.B., Hart A.L., Hindryckx P., et al. Third European Evidence-Based Consensus on Diagnosis and Management of Ulcerative Colitis. Part 1: Definitions, Diagnosis, Extra-Intestinal Manifestations, Pregnancy, Cancer Surveillance, Surgery, and Ileo-Anal Pouch Disorders. J. Crohns Colitis. 2017;11:649–670. doi: 10.1093/ecco-jcc/jjx008. - DOI - PubMed

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