title: Proctocolectomy for colorectal cancer--is the ileal pouch anal anastomosis a safe alternative to permanent ileostomy?
abstract: OBJECTIVE
  Ileal pouch anal anastomosis (IPAA) is the procedure of choice in patients requiring surgery for ulcerative colitis (UC) and familial adenomatous polyposis (FAP). There are few data on reconstruction with the IPAA in patients with colorectal cancer (CRC). This study assessed the outcomes of the IPAA compared to proctocolectomy and permanent ileostomy (PI) on these patients.
  
  
  METHODS
  Between 1983 and 2013, over 2800 patients with CRC have been treated at the Mount Sinai Hospital (MSH). Demographic, surgical, pathological, and outcome data for all patients have been maintained in a database-73 patients were treated for CRC with proctocolectomy: 39 patients with IPAA and 34 patients with PI. Clinical features, pathologic findings, and survival outcomes were compared between these groups.
  
  
  RESULTS
  Each group was similar with respect to gender, stage, and histologic grade. Patients undergoing IPAA were significantly younger. The diagnosis leading to proctocolectomy was more commonly UC or FAP in patients treated with IPAA (39/39 vs. 23/34, p = 0.001). Rectal cancer subgroups were similar in age, sex, TNM stage, T-stage, height of tumor, and histologic grade. There was no significant difference in overall or disease free survival between groups for colon or rectal primaries. Analysis using the Cochran-Armitage trend test suggests that utilization of IPAA has increased over time (p = 0.002).
  
  
  CONCLUSIONS
  The IPAA is a viable and safe option to select for patients who would otherwise require PI. Increased experience and improved outcomes following IPAA has led to its more liberal use in selected patients.
authors.affiliation: Department of Surgery, University of Toronto, Toronto, ON, Canada.
authors.forename: Ryan
authors.initials: R
authors.lastname: Snelgrove
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Brown
authors.forename: Brenda I
authors.initials: BI
authors.lastname: O'Connor
authors.forename: Harden
authors.initials: H
authors.lastname: Huang
authors.forename: J Charles
authors.initials: JC
authors.lastname: Victor
authors.forename: Robert
authors.initials: R
authors.lastname: Gryfe
authors.forename: Helen
authors.initials: H
authors.lastname: MacRae
authors.forename: Zane
authors.initials: Z
authors.lastname: Cohen
authors.forename: Robin S
authors.initials: RS
authors.lastname: McLeod
mesh_terms: D000328:Adult; D039021:Colonic Pouches; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007081:Ileostomy; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D016019:Survival Analysis; D016896:Treatment Outcome