Snelgrove Ryan, Brown Carl J, O'Connor Brenda I, Huang Harden, Victor J Charles, Gryfe Robert, MacRae Helen, Cohen Zane, McLeod Robin S
Department of Surgery, University of Toronto, Toronto, ON, Canada.
Int J Colorectal Dis. 2014 Dec;29(12):1485-91. doi: 10.1007/s00384-014-2027-3. Epub 2014 Oct 17.
Ileal pouch anal anastomosis (IPAA) is the procedure of choice in patients requiring surgery for ulcerative colitis (UC) and familial adenomatous polyposis (FAP). There are few data on reconstruction with the IPAA in patients with colorectal cancer (CRC). This study assessed the outcomes of the IPAA compared to proctocolectomy and permanent ileostomy (PI) on these patients.
Between 1983 and 2013, over 2800 patients with CRC have been treated at the Mount Sinai Hospital (MSH). Demographic, surgical, pathological, and outcome data for all patients have been maintained in a database-73 patients were treated for CRC with proctocolectomy: 39 patients with IPAA and 34 patients with PI. Clinical features, pathologic findings, and survival outcomes were compared between these groups.
Each group was similar with respect to gender, stage, and histologic grade. Patients undergoing IPAA were significantly younger. The diagnosis leading to proctocolectomy was more commonly UC or FAP in patients treated with IPAA (39/39 vs. 23/34, p = 0.001). Rectal cancer subgroups were similar in age, sex, TNM stage, T-stage, height of tumor, and histologic grade. There was no significant difference in overall or disease free survival between groups for colon or rectal primaries. Analysis using the Cochran-Armitage trend test suggests that utilization of IPAA has increased over time (p = 0.002).
The IPAA is a viable and safe option to select for patients who would otherwise require PI. Increased experience and improved outcomes following IPAA has led to its more liberal use in selected patients.
回肠储袋肛管吻合术（IPAA）是溃疡性结肠炎（UC）和家族性腺瘤性息肉病（FAP）患者手术治疗的首选术式。关于结直肠癌（CRC）患者行IPAA重建的资料较少。本研究评估了CRC患者行IPAA与直肠结肠切除术及永久性回肠造口术（PI）相比的疗效。
1983年至2013年间，超过2800例CRC患者在西奈山医院（MSH）接受治疗。所有患者的人口统计学、手术、病理和结局数据均保存在数据库中。73例CRC患者接受了直肠结肠切除术：39例行IPAA，34例行PI。比较两组患者的临床特征、病理结果和生存结局。
两组在性别、分期和组织学分级方面相似。接受IPAA的患者明显更年轻。导致直肠结肠切除术的诊断在接受IPAA治疗的患者中更常见于UC或FAP（39/39对23/34，p = 0.001）。直肠癌亚组在年龄、性别、TNM分期、T分期、肿瘤高度和组织学分级方面相似。结肠或直肠原发肿瘤患者组间总生存或无病生存无显著差异。使用 Cochr an-Armitage趋势检验分析表明，IPAA的应用随时间增加（p = 0.002）。
对于原本需要行PI的患者，IPAA是一种可行且安全的选择。IPAA经验的增加和疗效的改善导致其在特定患者中使用更为广泛。
