Pouch adenocarcinoma following restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) has been reported and reviewed. We present a case-report of poorly differentiated mucinous adenocarcinoma of the pouch following 13 years after IPAA for UC with entirely stapled anastomosis and the review of all the previous experiences in the published literature. The ileo-anal pouch mucosa and the anorectal mucosa below the ileo-anal anastomosis are at potential risk of developing dysplasia and adenocarcinoma. The risk of neoplastic degeneration of the mucosa remaining after RPC is very low, but it is assumed that it increases in time. Since the incidence of ileal pouch cancer after IPAA for RCU is 4.2% at 20 years and 5.1% at 25 years. The interval between IPAA and the development of cancer was 13 years in our patient. In the 38 cases reported to date, the cancers developed on average 10 years after construction of the IPAA. The longest reported interval was 27 years, the shortest 10 months. These data suggest the need of an endoscopic follow up to prevent or, occasionally, diagnose as early as possible, ileal pouch adenocarcinoma, which can occur both early or after many years by a PCR for RCU. For this reason it would be necessary to refer operated patients for a regular follow-up, ideally for the rest of life, which consists of endoscopic surveillance with multiple biopsies of the small residual rectal stump if present and of the pouch.

Adenocarcinoma on j-pouch after proctocolectomy for ulcerative colitis - Case report and review of literature (International Journal of Colorectal Disease DOI: 10.1007/s00384-014-1864-4)

MORELLI, LUCA;TARTAGLIA, DARIO;GUADAGNI, SIMONE;DI CANDIO, GIULIO;MOSCA, FRANCO
2014

Abstract

Pouch adenocarcinoma following restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) has been reported and reviewed. We present a case-report of poorly differentiated mucinous adenocarcinoma of the pouch following 13 years after IPAA for UC with entirely stapled anastomosis and the review of all the previous experiences in the published literature. The ileo-anal pouch mucosa and the anorectal mucosa below the ileo-anal anastomosis are at potential risk of developing dysplasia and adenocarcinoma. The risk of neoplastic degeneration of the mucosa remaining after RPC is very low, but it is assumed that it increases in time. Since the incidence of ileal pouch cancer after IPAA for RCU is 4.2% at 20 years and 5.1% at 25 years. The interval between IPAA and the development of cancer was 13 years in our patient. In the 38 cases reported to date, the cancers developed on average 10 years after construction of the IPAA. The longest reported interval was 27 years, the shortest 10 months. These data suggest the need of an endoscopic follow up to prevent or, occasionally, diagnose as early as possible, ileal pouch adenocarcinoma, which can occur both early or after many years by a PCR for RCU. For this reason it would be necessary to refer operated patients for a regular follow-up, ideally for the rest of life, which consists of endoscopic surveillance with multiple biopsies of the small residual rectal stump if present and of the pouch.
Morelli, Luca; Palmeri, Matteo; Tartaglia, Dario; Guadagni, Simone; DI CANDIO, Giulio; Mosca, Franco
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11568/766251
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