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Surgical resections of ulcerative colitis associated with dysplasia or carcinoma.

Sameshima S, Koketsu S, Takeshita E, Kubota Y, Okuyama T, Saito K, Ueda Y, Sawada T, Oya M - World J Surg Oncol (2015)

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Dokkyo Medical University Koshigaya Hospital, 2-1-50, Minami Koshigaya, Koshigaya, Saitama, 343-8555, Japan. shinsame@me.com.

ABSTRACT

Background: Ulcerative colitis (UC) patients have an increased risk of colorectal dysplasia and carcinoma. The purpose of this study was to analyze the clinical features and surgical treatment of ulcerative colitis associated with dysplasia or carcinoma.

Methods: We operated on 41 UC patients since April 2000. Twelve of the cases were associated with dysplasia or carcinoma. Ten patients were male and two were female; the median age was 58.0 years, and the average duration of disease was 19.2 years. Nine cases were pancolitis type and three were left-sided type. Six cases were remission-relapsing type and six were chronic inflammation type. In 10 of 12 cases, dysplasia or carcinoma was diagnosed before the operations. Nine cases were primary operations and two were second-time operations.

Results: Among ten patients who underwent primary operations, four patients had open surgery and six patients had hand-assisted laparoscopic surgery (HALS). Seven patients received anus/anal sphincter-preserving operations with reconstruction by the ileal pouch technique. Ileal pouch anal-canal anastomosis (IPACA) was performed in five cases and ileal pouch anal anastomosis (IPAA) in two cases. Abdomino-peritoneal resection was performed in two cases, proctcolectomy with permanent ileostomy in one case, and right hemicolectomy in one case. A 39-year-old patient was unresectable due to dissemination of the carcinoma. A 55-year-old patient who underwent IPACA showed night soiling postoperatively. Other patients who received IPAA and IPACA showed favorable anal function postoperatively. Histological examination showed low-grade dysplasia in two cases, high-grade dysplasia in three cases, and adenocarcinoma in seven cases. In the seven cases of adenocarcinoma, four, two, and one cases were stage 1, 3, and 4 according to TNM classification. Three of five cases with dysplasia were detected by surveillance colonoscopy. All patients with carcinoma were symptomatic and did not undergo surveillance colonoscopy.

Conclusions: IPACA by HALS was safely performed as an anal-preserving operation in UC patients with dysplasia or carcinoma. Non-anal-preserving operations for aged patients showed a preferable postoperative course. Surveillance colonoscopy is essential for detecting dysplasia before the development of carcinoma.

No MeSH data available.


Related in: MedlinePlus

Surgical procedures for primary resection in ulcerative colitis cases associated with dysplasia or carcinoma. Asterisk indicates the procedure was done by HALS; double asterisk indicates carcinoma was not diagnosed preoperatively. IPAA = ileal pouch anal anastomosis, IPACA = ileal pouch anal-canal anastomosis, HALS = hand-assisted laparoscopic surgery.
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Fig1: Surgical procedures for primary resection in ulcerative colitis cases associated with dysplasia or carcinoma. Asterisk indicates the procedure was done by HALS; double asterisk indicates carcinoma was not diagnosed preoperatively. IPAA = ileal pouch anal anastomosis, IPACA = ileal pouch anal-canal anastomosis, HALS = hand-assisted laparoscopic surgery.

Mentions: Ten cases were primary operations (FigureĀ 1), and two cases were second-time operations. In seven of ten primary operations, the anus and anal sphincter were preserved and permanent colostomy was avoided. Five IPACA cases underwent HALS. The average operation time for HALS was 310 min. The average bleeding volume was 350.6 g. In one patient in whom IPACA by HALS was started, IPAA was performed instead due to difficulties with the stapling anastomosis procedure. Two patients received permanent stoma. One 39-year-old female patient with carcinoma was unresectable due to peritoneal dissemination and underwent ileostomy instead.Figure 1


Surgical resections of ulcerative colitis associated with dysplasia or carcinoma.

Sameshima S, Koketsu S, Takeshita E, Kubota Y, Okuyama T, Saito K, Ueda Y, Sawada T, Oya M - World J Surg Oncol (2015)

Surgical procedures for primary resection in ulcerative colitis cases associated with dysplasia or carcinoma. Asterisk indicates the procedure was done by HALS; double asterisk indicates carcinoma was not diagnosed preoperatively. IPAA = ileal pouch anal anastomosis, IPACA = ileal pouch anal-canal anastomosis, HALS = hand-assisted laparoscopic surgery.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4340839&req=5

Fig1: Surgical procedures for primary resection in ulcerative colitis cases associated with dysplasia or carcinoma. Asterisk indicates the procedure was done by HALS; double asterisk indicates carcinoma was not diagnosed preoperatively. IPAA = ileal pouch anal anastomosis, IPACA = ileal pouch anal-canal anastomosis, HALS = hand-assisted laparoscopic surgery.
Mentions: Ten cases were primary operations (FigureĀ 1), and two cases were second-time operations. In seven of ten primary operations, the anus and anal sphincter were preserved and permanent colostomy was avoided. Five IPACA cases underwent HALS. The average operation time for HALS was 310 min. The average bleeding volume was 350.6 g. In one patient in whom IPACA by HALS was started, IPAA was performed instead due to difficulties with the stapling anastomosis procedure. Two patients received permanent stoma. One 39-year-old female patient with carcinoma was unresectable due to peritoneal dissemination and underwent ileostomy instead.Figure 1

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Dokkyo Medical University Koshigaya Hospital, 2-1-50, Minami Koshigaya, Koshigaya, Saitama, 343-8555, Japan. shinsame@me.com.

ABSTRACT

Background: Ulcerative colitis (UC) patients have an increased risk of colorectal dysplasia and carcinoma. The purpose of this study was to analyze the clinical features and surgical treatment of ulcerative colitis associated with dysplasia or carcinoma.

Methods: We operated on 41 UC patients since April 2000. Twelve of the cases were associated with dysplasia or carcinoma. Ten patients were male and two were female; the median age was 58.0 years, and the average duration of disease was 19.2 years. Nine cases were pancolitis type and three were left-sided type. Six cases were remission-relapsing type and six were chronic inflammation type. In 10 of 12 cases, dysplasia or carcinoma was diagnosed before the operations. Nine cases were primary operations and two were second-time operations.

Results: Among ten patients who underwent primary operations, four patients had open surgery and six patients had hand-assisted laparoscopic surgery (HALS). Seven patients received anus/anal sphincter-preserving operations with reconstruction by the ileal pouch technique. Ileal pouch anal-canal anastomosis (IPACA) was performed in five cases and ileal pouch anal anastomosis (IPAA) in two cases. Abdomino-peritoneal resection was performed in two cases, proctcolectomy with permanent ileostomy in one case, and right hemicolectomy in one case. A 39-year-old patient was unresectable due to dissemination of the carcinoma. A 55-year-old patient who underwent IPACA showed night soiling postoperatively. Other patients who received IPAA and IPACA showed favorable anal function postoperatively. Histological examination showed low-grade dysplasia in two cases, high-grade dysplasia in three cases, and adenocarcinoma in seven cases. In the seven cases of adenocarcinoma, four, two, and one cases were stage 1, 3, and 4 according to TNM classification. Three of five cases with dysplasia were detected by surveillance colonoscopy. All patients with carcinoma were symptomatic and did not undergo surveillance colonoscopy.

Conclusions: IPACA by HALS was safely performed as an anal-preserving operation in UC patients with dysplasia or carcinoma. Non-anal-preserving operations for aged patients showed a preferable postoperative course. Surveillance colonoscopy is essential for detecting dysplasia before the development of carcinoma.

No MeSH data available.


Related in: MedlinePlus