Inflammatory Bowel Disease Centre, Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands.
Center for Inflammatory Bowel Disease, Departments of Gastroenterology/Hepatology, Cleveland Clinic, Cleveland, Ohio.
Clin Gastroenterol Hepatol. 2016 Jun;14(6):798-806.e20. doi: 10.1016/j.cgh.2015.08.042. Epub 2015 Sep 25.
BACKGROUND & AIMS: Colorectal neoplasia can still develop after colectomy for inflammatory bowel disease. However, data on this risk are scare, and there have been few conclusive findings, so no evidence-based recommendations have been made for postoperative surveillance. We conducted a systematic review and meta-analysis to determine the prevalence and incidence of and risk factors for neoplasia in patients with inflammatory bowel disease who have undergone colectomy, including the permanent-end ileostomy and rectal stump, ileorectal anastomosis (IRA), and ileal pouch-anal anastomosis (IPAA) procedures.
We searched PubMed, Embase, Web of Science, and Cochrane Library through May 2014 to identify studies that reported prevalence or incidence of colorectal neoplasia after colectomy or specifically assessed risk factors for neoplasia development. Studies were selected, quality was assessed, and data were extracted by 2 independent researchers.
We calculated colorectal cancer (CRC) prevalence values from 13 studies of patients who underwent rectal stump surgery, 35 studies of IRA, and 33 studies of IPAA. Significantly higher proportions of patients in the rectal stump group (2.1%; 95% confidence interval [CI], 1.3%-3.0%) and in the IRA group (2.4%; 95% CI, 1.7%-3.0%) developed CRC than in the IPAA group (0.5%; 95% CI, 0.3%-0.6%); the odds ratio (OR) for CRC in the rectal stump or IRA groups compared with the IPAA group was 6.4 (95% CI, 4.3-9.5). A history of CRC was the most important risk factor for development of CRC after colectomy (OR for patients receiving IRA, 12.8; 95% CI, 3.31-49.2 and OR for patients receiving IPAA, 15.0; 95% CI, 6.6-34.5).
In a meta-analysis of published studies, we found the prevalence and incidence of CRC after colectomy to be less than 3%; in patients receiving IPAA it was less than 1%. Factors that increased risk of cancer development after colectomy included the presence of a residual rectum and a history of CRC. These findings could aid in development of individualized strategies for post-surgery surveillance.
炎症性肠病患者接受结肠切除术（包括永久性末端回肠造口术和直肠残端、回肠直肠吻合术（IRA）和回肠贮袋肛管吻合术（IPAA））后仍可能发生结直肠肿瘤。然而，有关该风险的数据有限，且尚未得出明确结论，因此尚未针对术后监测提出循证建议。我们进行了系统评价和荟萃分析，以确定接受结肠切除术（包括永久性末端回肠造口术和直肠残端、回肠直肠吻合术（IRA）和回肠贮袋肛管吻合术（IPAA））的炎症性肠病患者中结直肠肿瘤的发生率、患病率和危险因素。
我们通过 2014 年 5 月之前的 PubMed、Embase、Web of Science 和 Cochrane Library 检索，以确定报道结肠切除术后结直肠肿瘤发生率或患病率的研究，以及特别评估肿瘤发生发展危险因素的研究。由 2 名独立研究员选择研究、评估质量并提取数据。
我们从 13 项直肠残端手术、35 项 IRA 和 33 项 IPAA 研究中计算了结直肠癌（CRC）的患病率值。直肠残端组（2.1%；95%置信区间[CI]，1.3%-3.0%）和 IRA 组（2.4%；95% CI，1.7%-3.0%）的患者发生 CRC 的比例显著高于 IPAA 组（0.5%；95% CI，0.3%-0.6%）；与 IPAA 组相比，直肠残端或 IRA 组发生 CRC 的比值比（OR）为 6.4（95% CI，4.3-9.5）。CRC 病史是结肠切除术后发生 CRC 的最重要危险因素（IRA 组患者的 OR，12.8；95% CI，3.31-49.2；IPAA 组患者的 OR，15.0；95% CI，6.6-34.5）。
在对已发表研究的荟萃分析中，我们发现结肠切除术后 CRC 的患病率和发生率低于 3%；接受 IPAA 治疗的患者发生率低于 1%。增加结肠切除术后癌症发生风险的因素包括残留直肠和 CRC 病史。这些发现可能有助于制定术后监测的个体化策略。
