Risk of dysplasia in the columnar cuff after stapled restorative proctocolectomy.
BACKGROUND
Stapled restorative proctocolectomy (SRP) for ulcerative colitis retains a 'cuff' of columnar epithelium, which carries a risk of undergoing malignant change. The risk of neoplastic transformation was studied in a series of patients who underwent SRP for ulcerative colitis.


METHODS
One hundred and thirty-five patients who underwent SRP for ulcerative colitis between 1988 and 1998 were followed up by cuff surveillance biopsy. The median follow-up was 56 (range 12-145) months and the median time since diagnosis of ulcerative colitis was 8.8 (range 2-32) years.


RESULTS
The cuff biopsies showed no dysplasia or carcinoma. The accuracy of obtaining cuff mucosa in the biopsy was 65 per cent. Chronic inflammation was present in 94 per cent of cuff biopsies.


CONCLUSIONS
This study shows no evidence of either dysplasia or carcinoma in the columnar cuff mucosa, up to 12 years after pouch formation. This suggests that cuff surveillance in the first decade after SRP, in the absence of dysplasia or carcinoma in the original colectomy specimen, may be unnecessary. Regular cuff surveillance biopsies after SRP should continue for patients with high-grade dysplasia or carcinoma in the original resection specimen.
Coull
D B
DB
Department of Coloproctology, Glasgow Royal Infirmary, Glasgow G31 2ER, UK. domcoull@hotmail.com
Lee
F D
FD
Henderson
A P
AP
Anderson
J H
JH
McKee
R F
RF
Finlay
I G
IG
D002471:Cell Transformation, Neoplastic; D003093:Colitis, Ulcerative / Q000473:pathology / Q000601:surgery*; D003110:Colonic Neoplasms / Q000473:pathology*; D004847:Epithelial Cells; D005500:Follow-Up Studies; D006801:Humans; D007413:Intestinal Mucosa; D011230:Precancerous Conditions / Q000473:pathology*; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*; D012307:Risk Factors; D017792:Surgical Stapling / Q000009:adverse effects*