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Meta-Analysis
. 2023 Sep;27(9):699-712.
doi: 10.1007/s10151-023-02762-w. Epub 2023 Mar 12.

The incidence of malignancy in the residual rectum of IBD patients after colectomy: a systematic review and meta-analysis

I Georganta  1 , S McIntosh  1 , D Boldovjakova  1 , C N Parnaby  1 , A J M Watson  1 , G Ramsay  2
Affiliations
Meta-Analysis

The incidence of malignancy in the residual rectum of IBD patients after colectomy: a systematic review and meta-analysis

I Georganta et al. Tech Coloproctol. 2023 Sep.

Abstract

Background: Patients with inflammatory bowel disease (IBD) who have had a total colectomy remain with their rectum in situ, and are therefore at risk of rectal carcinoma. It is not clear how high the incidence of rectal cancer is in this cohort. The primary objective of this meta-analysis was to estimate the incidence of rectal cancer in patients with ulcerative colitis or Crohn's disease who have undergone colectomy but have a residual rectum, and to identify the risk factors for its development. In doing so, we explore the current recommendations for screening processes for these patients.

Methods: A systematic review of the literature was performed. Five databases (Medline, Embase, Pubmed, Cochrane Library and Scopus) were searched from inception to 29 October 2021, to identify studies adhering to the population, intervention, control and outcomes (PICO) criteria. The included studies were critically appraised, and the relevant data was extracted. Cancer incidence was estimated from the reported information. Risk stratification was analysed using RevMan. A narrative approach was undertaken for the exploration of the existing screening guidelines.

Results: Data from 23 of the 24 identified studies was suitable for analysis. The pooled incidence of rectal carcinoma was calculated to be 1.3%. Subgroup analysis showed an incidence of 0.7% and 3.2% for patients with a de-functioned rectal stump and ileorectal anastomosis, respectively. Patients with a history of a colorectal carcinoma were more likely to have a subsequent diagnosis of rectal carcinoma (RR 7.2, 95% CI 2.4-21.1). Patients with previous colorectal dysplasia were also at higher risk (RR 5.1, 95% CI 3.1-8.2). No universal standardised guidance regarding screening for this cohort could be identified in the available literature.

Conclusions: The overall risk of malignancy was estimated to be 1.3%, which is lower than previously reported. There is a need for clear and standardised screening guidance for this group of patients.

Keywords: Ileal–rectal anastomosis; Inflammatory bowel disease; Rectal malignancy; Rectal stump.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
PRISMA flowchart: Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Fig. 2
Fig. 2
Forest plot: Malignancy occurrence in patients with and without history of colorectal cancer (CRC)
Fig. 3
Fig. 3
Forest plot: Malignancy occurrence in patients with and without history of dysplasia
See this image and copyright information in PMC

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