RETROSPECTIVE REVIEW OF COLORECTAL-CANCER IN ULCERATIVE-COLITIS AT A TERTIARY CENTER

Objective: To review patient characteristics,surgical indications, ope rative procedures, and survival of patients with ulcerative colitis wh o develop colorectal cancer. Design: Retrospective medical record revi ew. Setting: Tertiary referral center. Patients: Of 493 patients who u nderwent surgery for ulcerative colitis between 1978 and 1994, 25 pati ents had colorectal cancer. Intervention: All patients underwent surgi cal exploration and either a biopsy, segmental resection, total abdomi nal colectomy, or restorative proctocolectomy was performed. Main Outc ome Measure: Duration of postoperative disease-free survival. Results: The average duration of illness prior to surgery was 18.5 years (rang e, 0.25-40 years). Surgical indications were intractability for 3 pati ents (12%); dysplasia as revealed by colonoscopic biopsy for 8 patient s (32%); and preoperatively diagnosed cancer for 14 patients (56%). Th ree patients (12%) underwent exploratory laparotomy, 3 (12%) underwent right hemicolectomy, 5 (20%) underwent total proctocolectomy with ile ostomy, 3 (12%) underwent total proctocolectomy with continent ileosto my, and 12 (48%) underwent restorative proctocolectomy. Pathological s tage was carcinoma in situ for 3 patients (12%), stage I for 7 patient s (28%), stage II for 4 patients (16%), stage III for 6 patients (25%) , and stage IV for 5 patients (20%). Five-year survival was 100% (3/3) for patients with carcinoma in situ, 100% (4/4) for those with stage I disease, 50% (2/4) for those with stage II, 25% (1/4) for those with stage III, and 0% (0/5) for those with stage ni. Of the 12 patients t reated with a restorative proctocolectomy, 6 are 5-year survivors, and 4 are alive at 24, 36, 38, and 48 months. Conclusions: Twelve percent of the patients in this series had no preoperative evidence of colore ctal malignant neoplasms but had invasive cancer in the resected speci men. Therefore, duration of disease alone may be an indication for sur gery. A restorative proctocolectomy is a satisfactory procedure in sel ected patients with malignant neoplasms.