ILEAL POUCH-ANAL ANASTOMOSIS IN PATIENTS WITH COLORECTAL-CANCER - LONG-TERM FUNCTIONAL AND ONCOLOGIC OUTCOMES

When colorectal cancer complicates chronic ulcerative colitis or famil ial adenomatous polyposis, the role of ileal pouch-anal anastomosis is uncertain because of concerns that the procedure may compromise oncol ogic therapy and that oncologic therapy may compromise pouch-anal anas tomosis function. AIM: This study was undertaken to investigate the im pact both of ileal pouch-anal anastomosis on cancer outcomes and of ca ncer treatments on ileal pouch-anal anastomosis function. PATIENTS AND METHODS: Of 1,616 patients undergoing ileal pouch-anal anastomosis fo r chronic ulcerative colitis or familial adenomatous polyposis (1981-1 994), 77 patients were identified with adenocarcinoma of the colon (56 ), rectum (17), or both (4). Data were obtained from an ileal pouch-an al anastomosis registry, case notes, and postal and telephone surveys. RESULTS: Mean age of the 77 index patients was 37 (range, 13-60) year s. Stage distribution was as follows: Stage 0, 9; Stage I, 31; Stage I I, 15; Stage III, 22 patients. Twelve patients died with systemic dise ase (6 with a local component) after a mean follow-up of 6 (range, 2-1 5) years. Twenty-two patients received adjuvant therapy (chemotherapy, 16; radiotherapy, 2; both, 4 patients). Chemotherapy complications re quiring dose reduction or interruption occurred in three (15 percent) patients. One patient developed radiation enteritis (17 percent). Pouc h failure occurred in 16 percent of cancer patients, compared with 7 p ercent for the overall registry. There were no differences between can cer and non-cancer groups in operative complications, median stool fre quency, incontinence, pad usage, or pouchitis. CONCLUSIONS: Although p ouch failure is more common, ileal pouch-anal anastomosis can be perfo rmed in the setting of colorectal cancer without significant impact on oncologic outcome or long-term ileal pouch-anal anastomosis function.