Ooi Boon Swee, Remzi Feza H, Gramlich Terry, Church James M, Preen Miriam, Fazio Victor W
Department of Colorectal Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Dis Colon Rectum. 2003 Oct;46(10):1418-23; discussion 1422-3. doi: 10.1007/s10350-004-6760-5.
Restorative proctocolectomy with ileal pouch-anal anastomosis is accepted as the surgical treatment of choice for many patients with familial adenomatous polyposis. The risk of cancer developing in the ileal pouch after this surgery is unknown. Cancer may arise from the ileal pouch after restorative proctocolectomy, but that arising from the anal transitional zone has not been documented in familial adenomatous polyposis. We report two cases of this cancer from the anal transitional zone in patients with familial adenomatous polyposis, with a review of the literature.
All patients with familial adenomatous polyposis treated with restorative proctocolectomy and ileal pouch-anal anastomosis in The Cleveland Clinic were included in the study. Patients whose surveillance biopsy of the anal transitional zone revealed invasive adenocarcinoma were studied.
Among a total of 146 patients with familial adenomatous polyposis who underwent restorative proctocolectomy and ileal pouch-anal anastomosis from 1983 to 2001 in our institution, none developed cancer of the anal transitional zone at up to 18 years of follow-up. However, there were two patients, both of whom underwent surgery elsewhere but who were followed up here, who developed invasive adenocarcinoma of the anal transitional zone. In one of them, cancer was diagnosed three years after a double-stapled ileal pouch-anal anastomosis, whereas in the other, cancer occurred eight years after a straight ileoanal anastomosis with mucosectomy.
Cancer may develop in the anal transitional zone after restorative proctocolectomy with ileal pouch-anal anastomosis for familial adenomatous polyposis. Long-term surveillance of the anal transitional zone needs to be emphasized.
回肠袋肛管吻合术式的结直肠切除重建术被公认为是许多家族性腺瘤性息肉病患者的首选外科治疗方法。该手术后回肠袋发生癌变的风险尚不清楚。结直肠切除重建术后，癌症可能起源于回肠袋，但家族性腺瘤性息肉病患者肛管移行区发生癌变的情况尚无文献记载。我们报告了2例家族性腺瘤性息肉病患者肛管移行区发生这种癌症的病例，并对相关文献进行了综述。
本研究纳入了在克利夫兰诊所接受结直肠切除重建术及回肠袋肛管吻合术治疗的所有家族性腺瘤性息肉病患者。对肛管移行区监测活检显示为浸润性腺癌的患者进行研究。
1983年至2001年期间，我院共有146例家族性腺瘤性息肉病患者接受了结直肠切除重建术及回肠袋肛管吻合术，随访长达18年，无一例发生肛管移行区癌变。然而，有2例患者在其他地方接受了手术，但在我院接受随访，发生了肛管移行区浸润性腺癌。其中1例在双吻合器回肠袋肛管吻合术后3年诊断出癌症，另1例在直式回肠肛管吻合术联合黏膜切除术后8年发生癌症。
家族性腺瘤性息肉病患者行回肠袋肛管吻合术式的结直肠切除重建术后，肛管移行区可能发生癌变。需要强调对肛管移行区进行长期监测。
