H. Ishii1, K. Hata1, J. Kishikawa1, H. Anzai1, K. Otani1, K. Yasuda1, T. Nishikawa1, T. Tanaka1, J. Tanaka1, T. Kiyomatsu1, K. Kawai1, H. Nozawa1, H. Yamaguchi1, S. Ishihara1, J. Kitayama1, T. Watanabe1 1Faculty Of Medicine, The University Of Tokyo,Department Of Surgical Oncology,Tokyo, , Japan
Introduction: The incidence of neoplasia after surgery of ulcerative colitis (UC) has not been sufficiently clarified, particularly in the Japanese population, and it is not evident whether surveillance endoscopy is effective for detecting dysplasia/cancer in the remnant rectum or pouch. The aims of the present study were to estimate and compare postoperative development of dysplasia/cancer in patients with UC who underwent ileorectal anastomosis (IRA) or ileal pouch-anal anastomosis (IPAA), and to evaluate the effectiveness of postoperative surveillance endoscopy.
Methods: We retrospectively reviewed 120 patients who received postoperative surveillance endscopy after IRA or IPAA in our institute for development of dysplasia/cancer in the remnant rectal mucosa or pouch.
Results: Three hundred seventy-nine endoscopy sessions were performed for 30 patients after IRA, while 548 pouch endoscopy sessions were performed for 90 patients after IPAA. In the IRA group, 5 patients developed dysplasia/cancer during postoperative surveillance and in all cases neoplasia was detected at an early stage. None of them developed neoplasia within 10 yr of diagnosis; the cumulative incidence of neoplasia after disease onset was 7.2, 12.0, and 23.9% at 15, 20, and 25 yr, respectively. In one case after stapled IPAA, dysplasia was found at the ileal pouch; a subsequent 9 endoscopy sessions in 8 years did not detect any dysplasia. Neoplasia was found more frequently during post-operative surveillance in the IRA group than in the IPAA group (p = .0028). The cumulative incidence of neoplasia after IRA was 3.8, 8.7, and 21.7% at 10, 15, and 20 yr, respectively, and that after IPAA was 1.6% at 20 yr.
Conclusion: The cumulative incidence of neoplasia after IPAA was minimal. Those who underwent IRA had a greater risk of developing neoplasia than those who underwent IPAA, although postoperative surveillance endoscopy was effective to detect dysplasia/cancer at an early stage. IRA can be an option of surgical procedure in selected cases in which it would be profitable to the patient, with more careful surveillance.