Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan.
Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan.
Asian J Surg. 2019 Jan;42(1):267-273. doi: 10.1016/j.asjsur.2018.01.003. Epub 2018 Feb 14.
BACKGROUND/OBJECTIVE: Restorative proctocolectomy (RP) may improve quality of life in patients with ulcerative colitis (UC)-associated lower rectal cancer to a greater extent than total proctocolectomy. However, patients with UC-associated cancer often have flat mucosal lesions that make it extremely difficult to endoscopically delineate the tumor margins. Therefore, there is a potential risk of residual tumor and local recurrence after RP in patients with UC-associated lower rectal cancer. The aim of this study was to assess the feasibility of RP in patients with UC-associated cancer of the lower rectum.
We retrospectively identified nine patients who had undergone RP for UC-associated lower rectal cancer at the Niigata University Medical and Dental Hospital between January 2000 and December 2016. The incidence of flat mucosal cancer, distal margin status, and oncologic outcomes were evaluated in the nine patients.
Eight (89%) of the nine patients had flat mucosal cancer in the lower rectum. The median length of the distal margin was 22 mm (range 0-55 mm). No patient developed local or distant recurrence during follow-up. One patient had a positive distal margin. This patient underwent annual pouchoscopy, but had no local recurrence and died of pancreatic cancer 81 months after RP. The remaining eight patients were alive at the final observation. Five-year and 10-year overall survival rates in the nine patients were 100% and 66.7%, respectively.
Patients with UC-associated lower rectal cancer often have lesions of the flat mucosal type. However, RP is feasible and not necessarily contraindicated in such patients.
背景/目的：与溃疡性结肠炎（UC）相关的低位直肠肿瘤患者行直肠结肠切除术（RP）可能比全直肠结肠切除术更能提高生活质量。然而，UC 相关癌症患者常有平坦的黏膜病变，这使得极难通过内镜描绘肿瘤边缘。因此，UC 相关低位直肠肿瘤患者行 RP 后有肿瘤残留和局部复发的潜在风险。本研究旨在评估 RP 在 UC 相关低位直肠肿瘤患者中的可行性。
我们回顾性地确定了 2000 年 1 月至 2016 年 12 月期间在新泻大学医学和牙科医院接受 RP 治疗的 9 例 UC 相关低位直肠肿瘤患者。评估了 9 例患者中扁平黏膜癌的发生率、远端切缘状态和肿瘤学结局。
9 例患者中有 8 例（89%）存在低位直肠的扁平黏膜癌。远端切缘的中位数为 22mm（范围 0-55mm）。在随访期间，没有患者发生局部或远处复发。1 例患者的远端切缘阳性。该患者接受了每年一次的储袋内镜检查，但无局部复发，RP 后 81 个月死于胰腺癌。其余 8 例患者在最后一次观察时仍存活。9 例患者的 5 年和 10 年总生存率分别为 100%和 66.7%。
与 UC 相关的低位直肠肿瘤患者常有平坦黏膜类型的病变。然而，RP 在这类患者中是可行的，并非一定禁忌。
