title: Disease course and management strategy of pouch neoplasia in patients with underlying inflammatory bowel diseases.
abstract: BACKGROUND
  To evaluate the disease course and management strategy for pouch neoplasia.
  
  
  METHODS
  Patients undergoing ileal pouch surgery for underlying ulcerative colitis who developed low-grade dysplasia (LGD), high-grade dysplasia, or adenocarcinoma in the pouch were identified.
  
  
  RESULTS
  All eligible 44 patients were evaluated. Of the 22 patients with initial diagnosis of pouch LGD, 6 (27.3%) had persistence or progression after a median follow-up of 9.5 (4.1-17.6) years. Family history of colorectal cancer was shown to be a risk factor associated with persistence or progression of LGD (P = 0.03). Of the 12 patients with pouch high-grade dysplasia, 5 (41.7%) had a history of (n = 2, 16.7%) or synchronous (n = 4, 33.3%) pouch LGD. Pouch high-grade dysplasia either persisted or progressed in 3 patients (25.0%) after the initial management, during a median time interval of 5.4 (2.2-9.2) years. Of the 14 patients with pouch adenocarcinoma, 12 (85.7%) had a history of (n = 2, 14.3%) or synchronous dysplasia (n = 12, 85.7%). After a median follow-up of 2.1 (0.6-5.2) years, 6 patients with pouch cancer (42.9%) died. Comparison of patients with a final diagnosis of pouch adenocarcinoma (14, 32.6%), and those with dysplasia (29, 67.4%) showed that patients with adenocarcinoma were older (P = 0.04) and had a longer duration from IBD diagnosis or pouch construction to the detection of pouch neoplasia (P = 0.007 and P = 0.0013).
  
  
  CONCLUSIONS
  The risk for progression of pouch dysplasia can be stratified. The presence of family history of colorectal cancer seemed to increase the risk for persistence or progression for patients with pouch LGD. The prognosis for pouch adenocarcinoma was poor.
authors.affiliation: Departments of *Colorectal Surgery, †Anatomic Pathology, and ‡Gastroenterology & Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Xian-Rui
authors.initials: XR
authors.lastname: Wu
authors.forename: Feza H
authors.initials: FH
authors.lastname: Remzi
authors.forename: Xiu-Li
authors.initials: XL
authors.lastname: Liu
authors.forename: Lei
authors.initials: L
authors.lastname: Lian
authors.forename: Luca
authors.initials: L
authors.lastname: Stocchi
authors.forename: Jean
authors.initials: J
authors.lastname: Ashburn
authors.forename: Bo
authors.initials: B
authors.lastname: Shen
mesh_terms: D000230:Adenocarcinoma / Q000209:etiology* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000209:etiology* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D039021:Colonic Pouches / Q000473:pathology*; D015179:Colorectal Neoplasms / Q000209:etiology* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate