INCIDENCE AND THERAPEUTIC IMPLICATIONS OF SYNCHRONOUS COLONIC PATHOLOGY IN COLORECTAL ADENOCARCINOMA

Background. The presence of synchronous benign and malignant colonic p athology may influence the magnitude of surgery for colorectal adenoca rcinoma. The aim of this prospective study was to quantitate the need for a more extensive surgical procedure because of synchronous patholo gy in colorectal cancer patients. Methods. Between 1984 and 1996, 235 consecutive patients were treated for colorectal adenocarcinoma. Preop erative survey of the colon in 228 patients included colonoscopy (91%) and double contrast barium enema (35.7%). Seven patients were exclude d for incomplete preoperative survey because of perforating or obstruc ting colon carcinoma or acute ulcerative colitis. Results. One hundred four patients (45.6%) had the following synchronous colonic lesions: benign polyps (68 patients, 29.8%), diverticular disease (30, 13.1%), ulcerative colitis (10, 4.4%), synchronous adenocarcinoma (8, 3.5%), a nd Crohn's colitis (3, 1.3%). Pathologic examination demonstrated thre e additional synchronous adenocarcinomas for a total of 11 patients (4 .9%). Twenty-five (11%) required more extensive surgery than dictated by the primary cancer. Of these 25 patients, 17 had a benign or premal ignant condition associated with their carcinoma and 8 had a synchrono us carcinoma. Seventeen patients underwent a sphincter-saving procedur e. Of the remaining eight patients requiring sphincter ablation, seven were needed because of a synchronous nonmalignant lesion, rather than because of the primary tumor. Conclusions. In our patient population, the incidence of synchronous colorectal lesions was 45.6%. Synchronou s colorectal cancer occurred in 4.9%. In 11%, the presence of synchron ous colorectal lesions made the surgical procedure more extensive than that dictated by the primary cancer, and in 3%, the need for a sphinc ter ablating procedure was dictated by a synchronous nonmalignant lesi on.