Department of Colorectal Surgery, the Cleveland Clinic Foundation, Cleveland, OH, USA.
J Crohns Colitis. 2013 Nov;7(10):e419-26. doi: 10.1016/j.crohns.2013.01.017. Epub 2013 Feb 27.
To evaluate the impact of preoperative radiation on pouch outcomes in patients with colitis-associated cancer (CAC).
CAC patients who underwent restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) from 1984 to 2009 were identified from our registry. The impact of preoperative pelvic radiation for CAC or other pelvic cancer on pouch related outcomes was evaluated.
Sixty-three pouch patients with confirmed CAC were included (37 male, 58.7%). The mean age at pouch construction was 46.9±10.6 years. Seven patients were excluded due to the presence of persistent diverting ileostomy (n=2) or no follow-up (n=5). The remaining 56 patients were analyzed, including 9 who received pelvic radiation prior to IPAA creation for CRC or other cancers. Preoperative pelvic radiation was significantly associated with chronic pouchitis (P=0.024). There was, however, no correlation between pelvic radiation and pouch/anal transitional zone neoplasia, pouch stricture, pelvic abscess and pouch fistula/sinus. Pouch failure occurred in 13 patients after a median follow-up of 66.4 (range: 2.7-322.2) months. Although a simple statistical analysis based on the number of patients with pouch failure did not achieve significance (4/9 vs. 9/47, P=0.19), Kaplan-Meier analysis showed a strong association between preoperative pelvic radiation and the risk for pouch failure (P<0.001). A subgroup analysis of rectal cancer patients revealed that 3/7 patients (42.9%) with radiation and 3/17 (17.6%) without had pouch failure (P=0.31). Again, the association between pelvic radiation and pouch failure was confirmed using Kaplan-Meier analysis (P=0.02).
Pelvic radiation administered prior to IPAA creation appears to be associated with poor pouch outcomes. Oncological benefits and pouch functional outcomes should be carefully balanced before pelvic radiation is considered prior to restorative proctocolectomy.
评估术前放疗对结肠炎相关性癌症（CAC）患者 pouch 结局的影响。
从我们的注册处确定了 1984 年至 2009 年间接受直肠结肠切除及回肠储袋肛管吻合术（IPAA）的 CAC 患者。评估了术前盆腔放疗对 CAC 或其他盆腔癌症对 pouch 相关结局的影响。
共纳入 63 例经 pouch 术治疗的 CAC 患者（男性 37 例，占 58.7%）。 pouch 手术时的平均年龄为 46.9±10.6 岁。由于存在持续性转流性回肠造口术（n=2）或无随访（n=5），7 例患者被排除在外。对剩余的 56 例患者进行了分析，其中 9 例患者在接受 IPAA 治疗前因 CRC 或其他癌症接受了盆腔放疗。术前盆腔放疗与慢性 pouchitis 显著相关（P=0.024）。然而，盆腔放疗与 pouch/anal 过渡区肿瘤、 pouch 狭窄、盆腔脓肿和 pouch 瘘管/窦道之间无相关性。中位随访 66.4（范围：2.7-322.2）个月后，13 例患者 pouch 失败。虽然基于 pouch 失败患者的数量进行的简单统计分析未达到显著性（4/9 例 vs. 9/47 例，P=0.19），但 Kaplan-Meier 分析显示术前盆腔放疗与 pouch 失败的风险之间存在强烈关联（P<0.001）。直肠 CA 患者的亚组分析显示，有 3/7（42.9%）例接受放疗的患者和 3/17（17.6%）例未接受放疗的患者 pouch 失败（P=0.31）。再次使用 Kaplan-Meier 分析证实了盆腔放疗与 pouch 失败之间的关联（P=0.02）。
在接受 IPAA 手术之前进行的盆腔放疗似乎与 pouch 结局不良有关。在考虑进行直肠结肠切除及回肠储袋肛管吻合术之前，应仔细权衡放疗的肿瘤学益处和 pouch 的功能结局。
