High Rates of Metachronous Colon Cancer or Dysplasia After Segmental Resection or Subtotal Colectomy in Crohnʼs Colitis

Abstract

The high rate of metachronous colon cancer after surgical resection suggests that total proctocolectomy should be considered. Larger studies are required to determine if the same is true for dysplasia.

Recent advances in clinical practice: a systematic review of isolated colonic Crohn's disease: the third IBD?

“…This contrasts with left-sided UC, where the tempting option of left hemicolectomy with right-sided colo-anal anastomosis consistently fails, usually with rapid recurrence of colitis in the retained colon 187. It should be noted though that segmental resection for colon cancer complicating colonic Crohn's disease has been associated with high (39%) risk for metachronous colon cancer188 suggesting that panproctocolectomy might be a safer option for such patients.…”

Indications and surgical options for small bowel, large bowel and perianal Crohn's disease

“…The rationale for total proctocolectomy is the high rate of metachronous cancers seen following segmental or subtotal colectomies associated with CD[75] - up to 40% for segmental resection, and 35% for subtotal colectomy. The mean time for development of metachronous cancer is approximately 7 years from initial surgery[75].…”

“…The rationale for total proctocolectomy is the high rate of metachronous cancers seen following segmental or subtotal colectomies associated with CD[75] - up to 40% for segmental resection, and 35% for subtotal colectomy. The mean time for development of metachronous cancer is approximately 7 years from initial surgery[75]. While the current guidelines recommend total proctocolectomy for CD associated colon cancer, a meta-analysis has shown increased risk of colon cancer but not rectal cancer in CD[26] and a total colectomy with surveillance of the remaining rectum is a reasonable option.…”

Detection of Dysplasia or Cancer in 3.5% of Patients With Inflammatory Bowel Disease and Colonic Strictures

“…In CD, there are limited data on the appropriate management of dysplasia. Nearly 50% of CD patients who underwent a total coloprotectomy or subtotal colectomy for dysplasia had multifocal dysplasia (19) and more than two thirds who had partial colectomy for dysplasia or cancer developed new dysplasia or cancer over time (20). All these findings suggest that total proctocolectomy should be considered in CD, and probably explain that about 50% of CD patients underwent total colectomy or coloprotectomy in our study.…”