Devon K M, Brown C J, Burnstein M, McLeod R S
Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada.
Dis Colon Rectum. 2009 Feb;52(2):211-6. doi: 10.1007/DCR.0b013e318197d0ad.
This study was designed to review the clinical and pathologic findings, treatment, and outcomes of patients who have a cancer that complicates perianal Crohn's disease.
Charts of patients who had documented perianal Crohn's disease and a pathologic diagnosis of anal carcinoma were reviewed.
There were 14 patients (6 men; mean age, 49 years) who had evidence of perianal Crohn's disease (mean, 6.9 (range, 1-20) years) before their cancer diagnosis. The diagnosis often was delayed despite increasing pain, multiple biopsies, and imaging studies. Ten patients had preoperative diagnoses of cancer; however, none of the eight magnetic resonance imaging studies were diagnostic. There were 11 adenocarcinomas (8 mucinous or colloid subtypes) and 3 squamous-cell carcinomas. Treatment included abdominoperineal resections plus chemotherapy in 12, and radiation and a defunctioning stoma in 1 patient. Of the 12 who had an abdominoperineal resection, 3 had posterior vaginectomies and rectus flap reconstructions. At last follow-up (mean, 41 (median, 22) months), five patients were alive without disease, five were alive with disease, and four had died.
Physicians should have a high level of suspicion of cancer in patients with longstanding perianal Crohn's disease who have a change in symptoms. In this series, patients who were diagnosed preoperatively and treated with multimodality therapy had better outcomes.
本研究旨在回顾患有肛周克罗恩病并发癌症患者的临床及病理表现、治疗情况和预后。
对有记录的肛周克罗恩病且经病理诊断为肛管癌的患者病历进行回顾。
有14例患者(6名男性;平均年龄49岁)在癌症诊断前有肛周克罗恩病证据(平均病程6.9年,范围1 - 20年)。尽管疼痛加剧、多次活检及影像学检查,诊断仍常被延误。10例患者术前诊断为癌症;然而,8次磁共振成像检查均未确诊。有11例腺癌(8例黏液性或胶样亚型)和3例鳞状细胞癌。治疗包括12例行腹会阴联合切除术加化疗,1例行放疗及造瘘术。12例行腹会阴联合切除术的患者中,3例行后阴道切除术及腹直肌皮瓣重建术。在最后一次随访时(平均41个月,中位数22个月),5例患者无病存活,5例患者带病存活,4例患者死亡。
对于症状有变化的长期肛周克罗恩病患者,医生应高度怀疑癌症。在本系列研究中,术前诊断并接受多模式治疗的患者预后较好。