[Colorectal cancers associated with ulcero-hemorrhagic rectocolitis. Detection of and prognosis for postoperative 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 the remainder of patients, except for three (n = 30, 35%) were at high risk for cancer. A colonoscopy performed in 16 of those 30 patients less than six months prior to the operation did not detect cancer. Overall, 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 tumors, Dukes' stage, Broder's stage, and curative/palliative ratio, remained unchanged, and the five-actuarial survival of 50% did not improve with time (p = 0.37). Multivariant analysis indicated that Dukes' stage and male gender were two poor prognosis factors. For patients with long-standing UC, we offer either proctocolectomy, possibly with ileal pouch-anal anastomosis, or surveillance colonoscopy, emphasizing their respective hazards and limitations.
Goudet
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Departement of Surgery, Mayo-Clinic, Rochester, MN 55905.
Dozois
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RR
Viard
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Ilstrup
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D000230:Adenocarcinoma / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D003093:Colitis, Ulcerative / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D015179:Colorectal Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies
Cancers colorectaux sur rectocolite ulcéro-hémorragique. Détection et pronostic des patients opérés.