Ileal pouch adenocarcinoma after proctocolectomy for familial adenomatous polyposis

Tajika, Masahiro; Nakamura, Tuneya; Bhatia, Vikram; Kono, Koji; Kato, Tomoyuki; Yamao, Kenji

doi:10.1007/s00384-009-0776-1

Cited by 12 publications

(10 citation statements)

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“…81 The cause of true pouch cancer seems to be different from the cancer arising from residual rectal or anal transitional epithelium, and the risks associated with these true pouches are controversial. 16 It has been suggested that TPC may not be a “cancer free” alternative to IRA. 86 Incidence of cancer in the ATZ in mucosectomized, handsewn IPAA, and stapled IPAA in patients with FAP have been reported in a study by von Roon et al 9 They surveyed 140 patients out of 260 who were followed-up endoscopically for a median of 10.3 years after RPC.…”

Section: Adenocarcinoma Of Ileal Pouch and Anal Transit Zonementioning

confidence: 99%

“…Thus even the ileal mucosa has the potential for malignant transformation. 16 Four surgical options are available for patients with FAP: 17–1920 colectomy with ileorectal anastomosis (IRA), restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis (IPAA), proctocolectomy with ileostomy, and proctocolectomy with continent ileostomy (Kock). Surgical treatment via TPC with mucosectomy to the dentate line is observed to reduce the incidence of cancer in the anal transit zone (ATZ) 212223 and a restorative IPAA preserves trans-anal defecation, but inadvertent small mucosal residual islands may remain.…”

Section: Introductionmentioning

confidence: 99%

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Adenocarcinomas after Prophylactic Surgery for Familial Adenomatous Polyposis

Smith¹,

Schaffer²,

Ballard³

et al. 2013

JCT

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The incidence of familial adenomatous polyposis (FAP) is one in 7,000 to 12,000 live births. Virtually, all surgically untreated patients with FAP inevitably develop colorectal-cancer in their lifetime because they carry the adenomatous polyposis coli gene. Thus prophylactic proctocolectomy is indicated. Surgical treatment of FAP is still controversial. There are however, four surgical options: ileorectal anastomosis, restorative proctocolectomy with ileal pouch-anal anastomosis, proctocolectomy with ileostomy, and proctocolectomy with continent-ileostomy. Conventional proctocolectomy options largely lie between colectomy with ileorectal anastomosis or ileal pouch-anal anastomosis. Detractors of ileal pouch-anal anastomosis prefer ileorectal anastomosis because of better functional results and quality of life. The functional outcome of total colectomy with ileorectal anastomosis is undoubtedly far superior to that of the ileoanal pouch; however, the risk for rectal cancer is increased by 30%. Even after mucosectomy, inadvertent small mucosal residual islands remain. These residual islands carry the potential for the development of subsequent malignancy. We reviewed the literature (1975–2012) on the incidence, nature, and possible etiology of subsequent ileal-pouch and anal transit zone adenocarcinoma after prophylactic surgery procedure for FAP. To date there are 24 studies reporting 92 pouch-related cancers; 15 case reports, 4 prospective and 5 retrospective studies. Twenty three of 92 cancers (25%) developed in the pouch mucosa and 69 (75%) in anal transit zone (ATZ). Current recommendation for pouch surveillance and treatment are presented. Data suggest lifetime surveillance of these patients.

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Section: Adenocarcinoma Of Ileal Pouch and Anal Transit Zonementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Adenocarcinomas after Prophylactic Surgery for Familial Adenomatous Polyposis

Smith¹,

Schaffer²,

Ballard³

et al. 2013

JCT

View full text Add to dashboard Cite

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“…To date, there are 27 reported cases of adenocarcinoma within the pouch itself [6,7,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] including our newly described case (Table 1), in addition to nearly 50 reported cases of adenocarcinoma at or near the anastomosis [5,10]. These reports suggest that true pouch cancers most often arise in patients with a history of neoplasia, typically many years following IPAA, and without postoperative endoscopic pouch surveillance.…”

Section: Discussionmentioning

confidence: 63%

“…More recently, the Standards Practice Task Force of the American Society of Colon and Rectal Surgeons looked at surveillance in UC patients and stated that outside of the symptoms, routine surveillance of the ileal pouch does not appear to be beneficial although surveillance of the rectal cuff or ATZ may be recommended to detect malignancy [29]. Notably however, in FAP patients, there is a recognized need for thorough pouch surveillance after IPAA, similar to patients with an ileorectal anastomosis [24,25,44].…”

Section: Discussionmentioning

confidence: 93%

“…A less common entity is a true pouch cancer with neoplastic change arising in the ileal mucosa of the pouch itself, distinctly separated from the ATZ. Twenty-six cases have been reported in the literature, and more than half of these have occurred in the last decade [6,7,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]. This recent surge in reported pouch cancers could be conceived as a serious health threat in IPAA patients as most present with advanced local disease and often many years following surgery.…”

Section: Introductionmentioning

confidence: 97%

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Adenocarcinoma of the ileal pouch mucosa: case report and literature review

O’Mahoney

Scherl

Lee

et al. 2014

Int J Colorectal Dis

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The risk of developing ileal pouch mucosa adenocarcinoma appears low. However, increasing reports of these cancers are concerning as most patients present with advanced disease after many years. Patients with a previous history of dysplasia/cancer may be at increased risk. We believe surveillance after IPAA should include the anal transition zone and the ileal pouch mucosa. The establishment of expert consensus guidelines on pouch surveillance should be considered in the near future.

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Long-term outcomes of pouch surveillance and risk of neoplasia in familial adenomatous polyposis

et al. 2023

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Background Long-term pouch surveillance outcomes for familial adenomatous polyposis (FAP) are unknown. We aimed to quantify surveillance outcomes and to determine which of selected possible predictive factors is associated with pouch dysplasia. Methods We performed retrospective analysis of collected data on 249 patients. We analysed potential risk factors for developing adenomas or advanced lesions (≥10mm/high grade dysplasia (HGD)/cancer) in the pouch body (PB) and cuff using Cox proportional hazards models. Kaplan-Meier analyses included landmark ‘time-point’ analyses at 10 years after surgery to predict future risk of advanced lesions. Results Of 249 patients, 75% developed ≥ 1 PB adenoma. Sixteen percent developed an advanced PB lesion; 18% developed an advanced cuff lesion. Kaplan-Meier analysis showed a 10-year lag before most advanced lesions developed in the PB or cuff; cumulative incidence of 2.8% and 6.4% at ten years in PB and cuff, respectively. Landmark-analysis suggested that presence of adenomas prior to the 10-year point is associated with subsequent development of advanced lesions in the PB [HR 4.8 (1.6-14.1), P=0.004] and cuff [HR 6.8 (2.5-18.3), p<0.001]. There were two HGD and four cancer cases in the cuff and one PB cancer; all cases of cancer/HGD which had prior surveillance were preceded by 10mm adenomas. Conclusions Pouch adenoma progression is slow and most advanced lesions occur after ten years. High grade dysplasia and cancer were rare events. Pouch phenotype in the first decade is associated with future risk of developing advanced lesions and may guide personalised surveillance beyond ten years.

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Ileal pouch adenocarcinoma after proctocolectomy for familial adenomatous polyposis

Cited by 12 publications

References 0 publications

Adenocarcinomas after Prophylactic Surgery for Familial Adenomatous Polyposis

Adenocarcinomas after Prophylactic Surgery for Familial Adenomatous Polyposis

Adenocarcinoma of the ileal pouch mucosa: case report and literature review

Long-term outcomes of pouch surveillance and risk of neoplasia in familial adenomatous polyposis

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