A prospective study of dysplasia and carcinoma in the rectal biopsies and rectal stump of eight patients following ileorectal anastomosis in ulcerative colitis

Abstract

The present study concerns eight patients with ulcerative colitis treated by total colectomy and ileorectal anastomosis and subjected to follow-up rectal biopsies who later developed precancer (two cases) or carcinoma in the retained rectum. We report the results of the biopsies and the detailed mapping of lesions in the resected rectal stump to highlight certain features which may lead to increased detection rate of early malignancy. Two groups of patients emerged. Group A: in all four cases the follow-up biopsies showed increasing severity of dysplasia; altered mucin secretion with predominance of sialomucins was seen in the biopsies even in the absence of inflammation or dysplasia; the biopsy findings (morphological and secretory) mirrored those observed in the rectal stump; in three, the lesions were villous polypoid growths, of which two were invasive carcinomas. Group B: in none of the cases was dysplasia seen in the biopsies and mucus secretion was normal; similar features were seen in the rectal stump; all had invasive carcinoma of which three were flat ulcerated lesions. The different behaviour of carcinoma in the two groups almost certainly reflects the different tumour phenotype characteristics and this is a matter for further study. From the practical point of view we emphasize the risk of relying on biopsy evidence of dysplasia alone as an indicator of malignancy and the need for additional immunological or histochemical tests to assess the individual risk of cancer in colitis.

Safety of Proctocolectomy for Ulcerative Colitis Under Elective and Non-Elective Circumstances: Preoperative Corticosteroid Treatment Worsens Outcome

“…Many authors recommend life-long endoscopic surveillance with biopsies in patients who retain their rectum [4,6,37,38] . In many cases, cancer of the retained rectum may develop from areas with dysplasia, but cancers may also be diagnosed in patients in whom dysplasia has never been detected [39,40] . It may, therefore, be a problematic and even fatal decision not to remove the rectum in patients who have recovered from a total colectomy.…”

Cancer surveillance strategies in ulcerative colitis

“…Endoscopic surveillance of the rectal cuff is thought to be useful; in many cases145, 146 dysplasia on biopsies precedes the development of rectal cancer. However, similar to the preoperative state, cancer can occur without any documented dysplasia on biopsies 147…”

Rectal Cancer Risk After Colectomy in Patients With Inflammatory Bowel Disease—A Population-Based Danish Cohort Study 1978–2018

“…[10][11][12] However, guidelines do not include clear recommendations for patients with a residual rectum, IRA or IPAA. The Danish guidelines, the Danish Society of Gastroenterology and Hepatology, 9 mention a potential increased risk of rectal cancer (RC) postcolectomy according to studies from the 1980s 13,14 and a referral center study from 2012. 15 The European Crohn's and Colitis Organization guideline/ consensus paper "European Evidence-based Consensus: Inflammatory Bowel Disease and Malignancies" mentions that "the risk of rectal cancer is relatively high in IBD patients after subtotal colectomy" without further recommendation.…”