COLORECTAL CANCERS ASSOCIATED WITH ULCERA TIVE-COLITIS - DETECTION AND PROGNOSIS OF OPERATED PATIENTS

Between January 1976 and December 1986, 86 patients underwent surgery for colorectal adenocarcinoma (AC) complicating ulcerative colitis (UC ) at Mayo Medical Center in Rochester, Minnesota. Seventy-two percent were men, contrasting with only 55 % in the population operated for UC without AC during the same time period at the same institution (p = 0 .001). The mean duration of UC symptoms was 19.2 years. The diagnosis of cancer was established preoperatively in 65 % of patients, while th e remainder of patients, except for three (n = 30, 35 %) were at high risk for cancer. A colonoscopy performed in 16 of those 30 patients le ss than six months prior to the operation did not detect cancer. Overa ll, cancer was either proven or highly suspected preoperatively in 96. 5 % of patients, while the sensitivity of colonoscopy was 78 %. During the study period, histological tumor features, such as number of tumo rs, Dukes' stage, Broder's stage, and curative/palliative ratio, remai ned unchanged, and the five-atuarial survival of 50 % did not improve with time (p = 0.37). Multivariat analysis indicated that Dukes' stage and male gender were two poor prognosis factors. For patients with lo ngstanding UC, we offer either proctocolectomy, possibly with ileal po uch-anal anastomosis, or surveillance colonoscopy, emphazing their res pective hazards and limitations.