Ziv Y, Fazio V W, Strong S A, Oakley J R, Milsom J W, Lavery I C
Department of Colorectal Surgery, Cleveland Clinic Foundation, OH 44195.
Ann Surg Oncol. 1994 Nov;1(6):512-5. doi: 10.1007/BF02303617.
The association between mucosal ulcerative colitis (MUC) and adenocarcinoma is well established.
Records of patients who had undergone restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) from 1983 through 1992 were examined. Of these, 604 had MUC and 27 (4.3%) had MUC with coexisting cancer. Patients were surveyed annually for recurrent disease. Pouch function and quality of life were evaluated with a questionnaire and physical examination.
The duration of disease was longer (p = 0.001) in patients with cancer (16.1 +/- 8.0 years) than in those without cancer (9.1 +/- 7.1 years), although the mean age at diagnosis of MUC was the same. Of the 27 patients, 20 had colon cancer and seven had rectal cancer. Multicentricity was found in seven (25.9%) patients. Using the TNM staging classification, 14 patients (51.8%) had stage 1 cancer, eight (29.6%) had stage 2, four (14.8%) had stage 3, and one (3.8%) had stage 4. The patient with stage 4 cancer died 5 months after surgery and was excluded from the follow-up analysis. During a mean follow-up time of 4.3 +/- 2.6 years, cancer recurred in two of the remaining 26 patients (7.7%). In one patient, a local recurrence was found 8 months after surgery, and distant metastases were found in the other patient 35 months after surgery. Both recurrences were in patients with colon cancer. Two of the 26 patients died; one death was related to cancer recurrence (3.8%). Pouch function is good to excellent in all surviving patients.
Restorative proctocolectomy for patients with MUC and coexisting colorectal cancer can be performed with a favorable prognosis and function. It is appropriate for curative intent, given that an adequate margin without tumor is obtained.
黏膜溃疡性结肠炎（MUC）与腺癌之间的关联已得到充分证实。
检查了1983年至1992年间接受回肠储袋肛管吻合术（IPAA）的直肠结肠切除术患者的记录。其中，604例患有MUC，27例（4.3%）患有MUC并伴有癌症。每年对患者进行复发性疾病调查。通过问卷调查和体格检查评估储袋功能和生活质量。
患有癌症的患者（16.1±8.0年）疾病持续时间比无癌症患者（9.1±7.1年）更长（p = 0.001），尽管MUC诊断时的平均年龄相同。27例患者中，20例患有结肠癌，7例患有直肠癌。7例（25.9%）患者发现有多中心性。采用TNM分期分类，14例（51.8%）患者为1期癌症，8例（29.6%）为2期，4例（14.8%）为3期，1例（3.8%）为4期。4期癌症患者术后5个月死亡，被排除在随访分析之外。在平均4.3±2.6年的随访时间内，其余26例患者中有2例（7.7%）癌症复发。1例患者术后8个月发现局部复发，另1例患者术后35个月发现远处转移。两次复发均发生在结肠癌患者中。26例患者中有2例死亡；1例死亡与癌症复发有关（3.8%）。所有存活患者的储袋功能良好至优秀。
对于患有MUC并伴有结直肠癌的患者，行直肠结肠切除术预后和功能良好。鉴于获得了无肿瘤的足够切缘，该手术适合用于根治性目的。
