Remzi F H, Preen M
Department of Colorectal Surgery A30, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio, USA.
Colorectal Dis. 2003 Sep;5(5):483-5. doi: 10.1046/j.1463-1318.2003.00505.x.
The aim of this study was to examine the incidence of coexisting colorectal cancer in ulcerative colitis in a population of patients undergoing ileal pouch anal anastomosis. The frequency of rectal cancer in this population, surgical intervention, general outcomes and cancer recurrence are described.
Data on 1850 patients undergoing restorative proctocolectomy from 1983 to 2001 were reviewed. Information was gathered from data in the department's pelvic pouch database, as well as pathology and surgical reports. Follow-up questionnaires routinely sent to patients as part of the database were included in the analysis to determine current functional status. Mean follow-up period was 7.5 years after surgery.
Seventy patients had coexisting colorectal cancer at time of IPAA. 7 (10%) of cancers were incidental. Pre-operative duration of disease was 18.6 years. Twenty-six of the cancers were rectal cancers. The most common form of anastomosis in the rectal cancers was mucosectomy, especially in pre-operatively known rectal cancer or low lying dysplasia. Preferred surgical technique for rectal cancer in mucosal ulcerative colitis (UC) included high ligation of mesenteric vessels with radical colectomy and taped occlusion of the rectum with irrigation of the rectal stump with Turnbull solution prior to mucosectomy. Patients with Stage 3 cancers received postoperative chemotherapy. Post-operative radiation therapy was not commonly recommended. Five of 70 patients were deceased from metastatic colon cancer; 55 patients were confirmed alive with good to excellent pouch function with a follow-up range of 1-17 years.
Restorative proctocolectomy with ileal pouch anal anastomosis is a successful surgical approach for patients with coexisting colorectal cancer in UC. When the appropriate surgical technique is used in patients with colon or rectal cancer, along with adjuvant chemotherapy when appropriate, prognosis and function is very good.
本研究旨在调查接受回肠储袋肛管吻合术的溃疡性结肠炎患者中并存结直肠癌的发生率。描述了该人群中直肠癌的发生率、手术干预、总体结局及癌症复发情况。
回顾了1983年至2001年期间1850例接受结直肠切除回肠储袋肛管吻合术患者的数据。信息收集自科室盆腔储袋数据库中的数据以及病理和手术报告。作为数据库一部分定期发送给患者的随访问卷纳入分析以确定当前功能状态。术后平均随访时间为7.5年。
70例患者在回肠储袋肛管吻合术时并存结直肠癌。其中7例（10%）癌症为偶然发现。术前病程为18.6年。26例癌症为直肠癌。直肠癌最常见的吻合方式是黏膜切除术，尤其在术前已知的直肠癌或低位发育异常患者中。黏膜性溃疡性结肠炎（UC）患者直肠癌的首选手术技术包括肠系膜血管高位结扎加根治性结肠切除术，以及在黏膜切除术前用Turnbull溶液冲洗直肠残端并胶带闭塞直肠。3期癌症患者接受术后化疗。术后放疗一般不推荐。70例患者中有5例死于转移性结肠癌；55例患者经证实存活，储袋功能良好至优秀，随访时间为1 - 17年。
结直肠切除回肠储袋肛管吻合术是治疗溃疡性结肠炎并存结直肠癌患者的一种成功手术方法。对结肠癌或直肠癌患者采用适当的手术技术，并在适当的时候联合辅助化疗，预后和功能非常好。
