Guthrie Robert Packer Hospital, Sayre, PA, USA.
Geisinger Commonwealth School of Medicine, Scranton, PA, USA.
Surg Endosc. 2022 Mar;36(3):1750-1760. doi: 10.1007/s00464-021-08847-7. Epub 2022 Jan 7.
This paper aimed to elucidate the etiologies of all primary ileostomy site malignancies published in the literature.
A review of the literature was conducted following PRISMA guidelines by querying PubMed, Global Health, and Web of Science for articles published before November 2020. Search criteria contained broad terminology for ileostomy site neoplasms without language, date, or publication limitations. A full-text review of the abstracts confirmed primary malignant pathologies and was evaluated for study inclusion.
Literature search discovered 858 publications, with 76 meeting eligibility criteria. The final sample contained 91 patients, with equal males and females. The mean age of patients with ileostomy site malignancy was 62.0 ± 12.2, with an average ileostomy age of 29.4 ± 12.4. The most common indications for ileostomy creation were inflammatory bowel disease (IBD) (73.6%) and familial adenomatous polyposis (FAP) (20.9%). There was a total of eight ileostomy malignant pathologies reported, with adenocarcinoma being the most common (76.9%), followed by squamous cell carcinoma (SCC) (11.0%). Adenocarcinoma was diagnosed at a younger age than SCC (59.7 vs. 72.3) and developed over a shorter time (28.8 vs. 37.0). Patients with FAP almost exclusively developed adenocarcinoma (94.4%) at a younger stoma age (25.8 vs. 31.4) than those with IBD who developed seven diverse pathologies. With a median follow-up of 0.75 years, four patients developed disease recurrence and received oncologic resection of their cancer less often than the 55 negative patients (p = 0.04).
Ileostomy site malignancies are late-appearing complications that require curative surgery. Their presentation is associated with ileostomy duration and creation indication, such as FAP or IBD. We recommend screening at a stoma age ≥ 20 or patient age ≥ 50 for patients with FAP, while stoma age ≥ 25 or patient age ≥ 60 for IBD patients.
本研究旨在阐明文献中报道的所有原发性回肠造口部位恶性肿瘤的病因。
按照 PRISMA 指南，通过检索 PubMed、全球健康和 Web of Science，检索了 2020 年 11 月之前发表的文章，以查找回肠造口部位肿瘤的文献。搜索标准包含了广泛的回肠造口部位肿瘤术语，但没有语言、日期或出版限制。对摘要的全文审查确认了原发性恶性病变，并对其进行了研究纳入评估。
文献检索发现了 858 篇出版物，其中 76 篇符合入选标准。最终样本包含 91 名患者，男女比例相等。回肠造口部位恶性肿瘤患者的平均年龄为 62.0±12.2 岁，回肠造口年龄平均为 29.4±12.4 岁。行回肠造口术的主要适应证为炎症性肠病（IBD）（73.6%）和家族性腺瘤性息肉病（FAP）（20.9%）。共报告了 8 种回肠造口恶性病变，其中腺癌最为常见（76.9%），其次是鳞状细胞癌（SCC）（11.0%）。腺癌的诊断年龄小于 SCC（59.7 岁 vs. 72.3 岁），且发病时间更短（28.8 岁 vs. 37.0 岁）。FAP 患者几乎仅发生腺癌（94.4%），造口年龄较 IBD 患者小（25.8 岁 vs. 31.4 岁），而 IBD 患者发生了 7 种不同的病变。中位随访 0.75 年时，4 名患者出现疾病复发，接受癌症根治性切除的比例低于 55 名阴性患者（p=0.04）。
回肠造口部位恶性肿瘤是迟发性并发症，需要进行根治性手术。其表现与回肠造口术持续时间和造口适应证有关，如 FAP 或 IBD。我们建议对 FAP 患者在造口年龄≥20 岁或患者年龄≥50 岁时进行筛查，而对 IBD 患者在造口年龄≥25 岁或患者年龄≥60 岁时进行筛查。
