Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy.
IRCCS Humanitas Research Hospital, Division of Colon and Rectal Surgery, via Manzoni 56, 20089 Rozzano, Milan, Italy.
J Crohns Colitis. 2022 Feb 23;16(2):244-250. doi: 10.1093/ecco-jcc/jjab139.
Few recent studies focus on the treatment of rectal cancer in patients with ulcerative colitis. We report treatment options and results for this subset of patients with a multimodal approach at two European referral centres.
Ulcerative colitis patients diagnosed with rectal cancer arising at less than 15 cm from the anal verge between January 2010 and December 2020 were analysed. Demographics, clinical data, and details of medical and surgical treatment were retrieved from prospectively collected institutional databases.
Of 132 patients with ulcerative colitis and concomitant colorectal cancer, rectal cancer was diagnosed in 46. The median time between disease onset and rectal cancer diagnosis was 17.5 years; 21/46 were preoperatively staged as early tumours [cT1-T2/N0]. Eleven patients received neoadjuvant chemoradiotherapy for locally advanced extraperitoneal adenocarcinoma, and the rest underwent surgery first. Over two-thirds of the procedures were restorative [68%]; a minimally invasive approach was used in 96% of patients, with no conversion to open. The median follow-up was 44 months. Local recurrence occurred in three patients [6%]. The cumulative 3-year cancer-specific survival rate was 94% [and the 3-year disease-free rate was 86%].
Rectal cancer in ulcerative colitis is a very complex condition. Our results show that surgery for rectal cancer can be delivered with excellent oncological and functional outcomes in patients with ulcerative colitis. A multidisciplinary discussion among surgeons, gastroenterologists, and medical oncologists is key to ensure the appropriate treatment pathway for individual patients.
鲜有研究关注溃疡性结肠炎合并直肠癌患者的治疗方法。我们报告了两家欧洲转诊中心采用多模式方法治疗这部分患者的治疗选择和结果。
分析了 2010 年 1 月至 2020 年 12 月期间距肛门缘小于 15cm 处诊断为直肠癌的溃疡性结肠炎患者。从前瞻性收集的机构数据库中检索人口统计学、临床数据以及医疗和手术治疗的详细信息。
在 132 例溃疡性结肠炎合并结直肠癌患者中，有 46 例诊断为直肠癌。疾病发作和直肠癌诊断之间的中位时间为 17.5 年；21/46 例术前分期为早期肿瘤[cT1-T2/N0]。11 例局部晚期腹膜外腺癌患者接受新辅助放化疗，其余患者先接受手术治疗。超过三分之二的手术为保肛手术[68%]；96%的患者采用微创方法，无中转开腹。中位随访时间为 44 个月。3 例患者（6%）发生局部复发。累积 3 年癌症特异性生存率为 94%[无病生存率为 86%]。
溃疡性结肠炎合并直肠癌是一种非常复杂的情况。我们的结果表明，对于溃疡性结肠炎患者，直肠癌手术可以获得优异的肿瘤学和功能学结果。外科医生、胃肠病学家和肿瘤内科医生之间的多学科讨论是确保为每位患者制定适当治疗方案的关键。
