Le Cosquer Guillaume, Buscail Etienne, Gilletta Cyrielle, Deraison Céline, Duffas Jean-Pierre, Bournet Barbara, Tuyeras Géraud, Vergnolle Nathalie, Buscail Louis
Department of Gastroenterology and Pancreatology, CHU Toulouse-Rangueil (University Hospital Centre) and Toulouse University, UPS, 31059 Toulouse, France.
Department of Surgery, CHU Toulouse-Rangueil and Toulouse University, UPS, 31059 Toulouse, France.
Cancers (Basel). 2022 Jan 21;14(3):530. doi: 10.3390/cancers14030530.
Proctocolectomy with ileal pouch-anal anastomosis is the intervention of choice for ulcerative colitis and familial adenomatous polyposis requiring surgery. One of the long-term complications is pouch cancer, having a poor prognosis. The risk of high-grade dysplasia and cancer in the anal transitional zone and ileal pouch after 20 years is estimated to be 2 to 4.5% and 3 to 10% in ulcerative colitis and familial polyposis, respectively. The risk factors for ulcerative colitis are the presence of pre-operative dysplasia or cancer, disease duration > 10 years and severe villous atrophy. For familial polyposis, the risk factors are the number of pre-operative polyps > 1000, surgery with stapled anastomosis and the duration of follow-up. In the case of ulcerative colitis, a pouchoscopy should be performed annually if one of the following is present: dysplasia and cancer at surgery, primary sclerosing cholangitis, villous atrophy and active pouchitis (every 5 years without any of these factors). In the case of familial polyposis, endoscopy is recommended every year including chromoendoscopy. Even if anal transitional zone and ileal pouch cancers seldom occur following proctectomy for ulcerative colitis and familial adenomatous polyposis, the high mortality rate associated with this complication warrants endoscopic monitoring.
回肠贮袋肛管吻合术式全直肠系膜切除术是溃疡性结肠炎和需要手术治疗的家族性腺瘤性息肉病的首选干预措施。长期并发症之一是贮袋癌，预后较差。据估计，20年后溃疡性结肠炎和家族性息肉病患者肛管移行区和回肠贮袋发生高级别上皮内瘤变和癌的风险分别为2%至4.5%和3%至10%。溃疡性结肠炎的危险因素包括术前存在上皮内瘤变或癌、病程>10年以及严重绒毛萎缩。对于家族性息肉病，危险因素包括术前息肉数量>1000、采用吻合器吻合的手术方式以及随访时间。对于溃疡性结肠炎患者，如果存在以下情况之一，应每年进行一次贮袋内镜检查：手术时存在上皮内瘤变和癌、原发性硬化性胆管炎、绒毛萎缩以及活动性贮袋炎（无上述任何因素时每5年检查一次）。对于家族性息肉病患者，建议每年进行包括色素内镜检查在内的内镜检查。尽管溃疡性结肠炎和家族性腺瘤性息肉病患者行直肠切除术后肛管移行区和回肠贮袋癌很少发生，但与该并发症相关的高死亡率仍需要进行内镜监测。
