ULCERATIVE-COLITIS AND COEXISTING COLORECTAL-CANCER - RECURRENCE RATEAFTER RESTORATIVE PROCTOCOLECTOMY

Background: The association between mucosal ulcerative colitis (MUC) a nd adenocarcinoma is well established. Methods: Records of patients wh o had undergone restorative proctocolectomy with ileal pouch-anal anas tomosis (IPAA) from 1983 through 1992 were examined. Of these, 604 had MUC and 27 (4.3%) had MUC with coexisting cancer. Patients were surve yed annually for recurrent disease. Pouch function and quality of life were evaluated with a questionnaire and physical examination. Results : The duration of disease was longer (p = 0.001) in patients with canc er (16.1 +/- 8.0 years) than in those without cancer (9.1 +/- 7.1 year s), although the mean age at diagnosis of MUC was the same. Of the 27 patients, 20 had colon cancer and seven had rectal cancer. Multicentri city was found in seven (25.9%) patients. Using the TNM staging classi fication, 14 patients (51.8%) had stage 1 cancer, eight (29.6%) had st age 2, four (14.8%) had stage 3, and one (3.8%) had stage 4. The patie nt with stage 4 cancer died 5 months after surgery and was excluded fr om the follow-up analysis. During a mean follow-up time of 4.3 +/- 2.6 years, cancer recurred in two of the remaining 26 patients (7.7%). In one patient, a local recurrence was found 8 months after surgery, and distant metastases were found in the ether patient 35 months after su rgery. Both recurrences were in patients with colon cancer. Two of the 26 patients died; one death was related to cancer recurrence (3.8%). Pouch function is good to excellent in all surviving patients. Conclus ions: Restorative proctocolectomy for patients with MUC and coexisting colorectal cancer can be performed with a favorable prognosis and fun ction. It is appropriate for curative intent, given that an adequate m argin without tumor is obtained.