Abstract：
OBJECTIVE: Total proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the treatment of choice for colorectal cancer (CRC) in inflammatory bowel disease. CRC may also be discovered incidentally at IPAA for other indications. We sought to determine whether incidentally found CRC at IPAA was associated with worse outcomes.
METHODS: Our institutional pouch registry (1983-2021) was retrospectively reviewed. Patients with CRC at pathology after IPAA were divided into two groups: a preoperative diagnosis (PreD) group and an incidental diagnosis (InD) group. Their long-term outcomes (overall survival, disease-free survival and pouch survival) were compared.
RESULTS: We included 164 patients: 53 (32%) InD and 111 (68%) PreD. There were no differences in cancer staging, differentiation and location. After a median follow-up of 11 (IQR 3-25) years for InD and 9 (IQR 3-20) years for the PreD group, deaths were 14 (26%) in the InD group and 18 (16%) in the PreD group. Pouch failures were five (9%) in the InD group and nine (8%) in the PreD group, of which two (5%) and four (4%) were cancer related. Ten-year overall survival was 94% for InD and 89% for PreD (P = 0.41), disease-free survival was 95% for InD and 90% for PreD (P = 0.685) and pouch survival was 89% for InD and 97% for PreD (P = 0.80). Pouch survival at 10 years was lower in rectal versus colon cancer (87% vs. 97%, P = 0.01). No difference was found in outcomes in handsewn versus stapled anastomoses.
CONCLUSIONS: Inflammatory bowel disease patients with incidentally found CRC during IPAA appear to have similarly excellent oncological and pouch outcomes to patients with a preoperative cancer diagnosis.
METHODS: Our institutional pouch registry (1983-2021) was retrospectively reviewed. Patients with CRC at pathology after IPAA were divided into two groups: a preoperative diagnosis (PreD) group and an incidental diagnosis (InD) group. Their long-term outcomes (overall survival, disease-free survival and pouch survival) were compared.
RESULTS: We included 164 patients: 53 (32%) InD and 111 (68%) PreD. There were no differences in cancer staging, differentiation and location. After a median follow-up of 11 (IQR 3-25) years for InD and 9 (IQR 3-20) years for the PreD group, deaths were 14 (26%) in the InD group and 18 (16%) in the PreD group. Pouch failures were five (9%) in the InD group and nine (8%) in the PreD group, of which two (5%) and four (4%) were cancer related. Ten-year overall survival was 94% for InD and 89% for PreD (P = 0.41), disease-free survival was 95% for InD and 90% for PreD (P = 0.685) and pouch survival was 89% for InD and 97% for PreD (P = 0.80). Pouch survival at 10 years was lower in rectal versus colon cancer (87% vs. 97%, P = 0.01). No difference was found in outcomes in handsewn versus stapled anastomoses.
CONCLUSIONS: Inflammatory bowel disease patients with incidentally found CRC during IPAA appear to have similarly excellent oncological and pouch outcomes to patients with a preoperative cancer diagnosis.
摘要：
目的：全结直肠切除加回肠袋-肛门吻合术（IPAA）是治疗结直肠癌（CRC）炎症性肠病的首选方法。对于其他适应症，也可以在IPAA偶然发现CRC。我们试图确定在IPAA时偶然发现的CRC是否与更差的结果相关。
方法：我们的机构邮袋注册（1983-2021）进行了回顾性审查。将IPAA术后病理的CRC患者分为两组：术前诊断（PreD）组和偶然诊断（InD）组。他们的长期结果(总体生存率，比较了无病生存率和育儿袋生存率）。
结果：我们包括164例患者：53（32%）InD和111（68%）PreD。癌症分期没有差异，差异化和定位。InD组的中位随访时间为11年（IQR3-25），PreD组的中位随访时间为9年（IQR3-20），InD组死亡14例(26%),PreD组死亡18例(16%).InD组中有5个（9％），PreD组中有9个（8％），其中两个（5％）和四个（4％）与癌症有关。InD的10年总生存率为94%，PreD为89%(P=0.41)。InD的无病生存率为95%,PreD的无病生存率为90%(P=0.685),InD的无病生存率为89%,PreD的无病生存率为97%(P=0.80).直肠癌与结肠癌相比，10年的袋生存率较低（87％与97%,P=0.01）。手工缝合与缝合吻合的结果没有差异。
结论：在IPAA期间偶然发现CRC的炎症性肠病患者似乎具有与术前诊断为癌症的患者相似的优异的肿瘤学和囊袋预后。
方法：我们的机构邮袋注册（1983-2021）进行了回顾性审查。将IPAA术后病理的CRC患者分为两组：术前诊断（PreD）组和偶然诊断（InD）组。他们的长期结果(总体生存率，比较了无病生存率和育儿袋生存率）。
结果：我们包括164例患者：53（32%）InD和111（68%）PreD。癌症分期没有差异，差异化和定位。InD组的中位随访时间为11年（IQR3-25），PreD组的中位随访时间为9年（IQR3-20），InD组死亡14例(26%),PreD组死亡18例(16%).InD组中有5个（9％），PreD组中有9个（8％），其中两个（5％）和四个（4％）与癌症有关。InD的10年总生存率为94%，PreD为89%(P=0.41)。InD的无病生存率为95%,PreD的无病生存率为90%(P=0.685),InD的无病生存率为89%,PreD的无病生存率为97%(P=0.80).直肠癌与结肠癌相比，10年的袋生存率较低（87％与97%,P=0.01）。手工缝合与缝合吻合的结果没有差异。
结论：在IPAA期间偶然发现CRC的炎症性肠病患者似乎具有与术前诊断为癌症的患者相似的优异的肿瘤学和囊袋预后。
