The Henry D. Janowitz Division of Gastroenterology, Department of Medicine, The Mount Sinai Hospital, New York, NY 10029, USA.
Inflamm Bowel Dis. 2013 Aug;19(9):1827-32. doi: 10.1097/MIB.0b013e318289c166.
In ulcerative colitis, total proctocolectomy is the treatment of choice for patients with colonic dysplasia or cancer because of the high risk for metachronous neoplasia. It is unknown whether patients with Crohn's disease and colon cancer or dysplasia have a similar risk.
We retrospectively reviewed the charts of 75 patients treated at our center from 2001 to 2011 with Crohn's disease and colon cancer who underwent segmental resection or subtotal colectomy (STC). We then identified the presence or absence of subsequent colon cancer or dysplasia in these patients during the follow-up (0-19 years).
Of the 64 patients with colon cancer, 25 had at least 1 metachronous cancer (39%). The mean time to a new cancer was 6.8 years. Eighty-five percent of patients (21/25) were undergoing annual screening colonoscopy. Of the 11 patients with dysplasia, 5 (46%) had a new dysplasia. Mean time to a new dysplastic lesion was 5.0 years. Nineteen of the 47 patients (40%) who had a segmental resection for colon cancer developed metachronous cancer and 6/17 patients (35%) with a STC had metachronous cancer. Two of the 4 patients (50%) with STC for dysplasia (50%) had a new dysplasia and 3/7 patients (43%) with segmental resection had a new dysplasia. There was no significant difference (P = 0.61) between recurrence rates in patients with segmental resection versus STC.
The high rate of metachronous colon cancer after surgical resection suggests that total proctocolectomy should be considered. Larger studies are required to determine if the same is true for dysplasia.
在溃疡性结肠炎中，由于存在同时发生的肿瘤的高风险，全直肠结肠切除术是伴有结肠异型增生或癌症的患者的治疗选择。尚不清楚患有克罗恩病和结肠癌或异型增生的患者是否具有相似的风险。
我们回顾性分析了 2001 年至 2011 年在我们中心接受治疗的 75 例克罗恩病合并结肠癌患者的病历，这些患者接受了节段切除术或次全结肠切除术（STC）。然后，我们在随访期间（0-19 年）确定这些患者是否存在随后的结肠癌或异型增生。
在 64 例结肠癌患者中，有 25 例患者至少存在 1 例同时性癌症（39%）。新发癌症的平均时间为 6.8 年。85%的患者（21/25）正在接受年度筛查结肠镜检查。在 11 例异型增生患者中，有 5 例（46%）存在新的异型增生。新发异型增生病变的平均时间为 5.0 年。47 例因结肠癌行节段切除术的患者中有 19 例（40%）发生同时性癌症，17 例接受 STC 的患者中有 6 例（35%）发生同时性癌症。4 例因异型增生行 STC 的患者中有 2 例（50%）出现新的异型增生，7 例因节段切除术的患者中有 3 例（43%）出现新的异型增生。节段切除术与 STC 患者的复发率之间无显著差异（P=0.61）。
手术后同时发生结肠癌的高发生率提示应考虑全直肠结肠切除术。需要更大规模的研究来确定异型增生是否也是如此。
