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. 2024 Sep 3;8(5):zrae074.
doi: 10.1093/bjsopen/zrae074.

Incidence of rectal cancer after colectomy for inflammatory bowel disease: nationwide study

Mohammed Deputy  1   2 , Guy Worley  1   2 , Elaine M Burns  1   2 , Alex Bottle  3 , Paul Aylin  3 , Ailsa Hart  2   4 , Omar Faiz  1   2
Affiliations

Incidence of rectal cancer after colectomy for inflammatory bowel disease: nationwide study

Mohammed Deputy et al. BJS Open. .

Abstract

Background: Inflammatory bowel disease increases the risk of colorectal neoplasia. A particular problem arises in patients who have undergone subtotal colectomy leaving a rectal remnant. The risk of future rectal cancer must be accurately estimated and weighed against the risks of further surgery or surveillance. The aim of this study was to estimate the 10-year cumulative incidence of rectal cancer in such patients.

Methods: A nationwide study using England's hospital administrative data was performed. A cohort of patients undergoing subtotal colectomy between April 2002 and March 2014 was identified. A competing risks survival analysis was performed to calculate the cumulative incidence of rectal cancer. The effect of the COVID-19 pandemic on endoscopic surveillance was investigated using time-trend analysis.

Results: A total of 8120 patients were included and 61 patients (0.8%) were diagnosed with cancer. The cumulative incidence of rectal cancer was 0.26% (95% c.i. 0.17% to 0.39%), 0.49% (95% c.i. 0.36% to 0.68%), and 0.77% (95% c.i. 0.57% to 1.02%) at 5, 10, and 15 years respectively. A previous diagnosis of colonic dysplasia (HR 3.34, 95% c.i. 1.01 to 10.97; P = 0.047), primary sclerosing cholangitis (HR 5.42, 95% c.i. 1.34 to 21.85; P = 0.018), and elective colectomy (HR 1.83, 95% c.i. 1.11 to 3.02; P = 0.018) was associated with an increased incidence of rectal cancer. Regarding endoscopic surveillance, there was a 43% decline in endoscopic procedures performed in 2020 (333 procedures) compared with 2019 (585 procedures).

Conclusion: The incidence of rectal cancer after subtotal colectomy is low. Asymptomatic patients without evidence of rectal dysplasia should be carefully counselled on the possible benefits and risks of prophylactic proctectomy.

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Figures

Fig. 1
Fig. 1
Flow chart of patients included in the present study UC, ulcerative colitis; CD, Crohn’s disease; IBD-U, inflammatory bowel disease unclassified.
Fig. 2
Fig. 2
Cumulative incidence function plot for rectal cancer diagnosis CD, Crohn’s disease; IBD-U, inflammatory bowel disease unclassified; UC, ulcerative colitis.
Fig. 3
Fig. 3
Cumulative incidence function plots for competing events (death, proctectomy alone, and pouch reconstruction) separated by diagnosis a Death (Gray’s test for equality, P < 0.0001). b Proctectomy alone (P = 0.0006). c Pouch reconstruction (P < 0.0001). CD, Crohn’s disease; IBD-U, inflammatory bowel disease unclassified; UC, ulcerative colitis.
Fig. 4
Fig. 4
Frequency of endoscopic surveillance of the rectal remnant from January 2016 to March 2021
See this image and copyright information in PMC

References

    1. Beaugerie L, Itzkowitz SH. Cancers complicating inflammatory bowel disease. N Engl J Med 2015;372:1441–1452 - PubMed
    1. Kabir M, Thomas-Gibson S, Hart AL, Tozer PJ, Faiz O, Warusavitarne J et al. Management of inflammatory bowel disease associated colonic dysplasia: factors predictive of patient choice and satisfaction. Colorectal Dis 2021;23:882–893 - PubMed
    1. Derikx LAAP, Nissen LHC, Smits LJT, Shen B, Hoentjen F. Risk of neoplasia after colectomy in patients with inflammatory bowel disease: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2016;14:798–806.e20 - PubMed
    1. Adami H-O, Bretthauer M, Emilsson L, Hernán MA, Kalager M, Ludvigsson JF et al. The continuing uncertainty about cancer risk in inflammatory bowel disease. Gut 2016;65:889–893 - PMC - PubMed
    1. Deputy M, Sahnan K, Worley G, Patel K, Balinskaite V, Bottle A et al. The use of, and outcomes for, inflammatory bowel disease services during the Covid-19 pandemic: a nationwide observational study. Aliment Pharmacol Ther 2022;55:836–846 - PMC - PubMed