title: Impaired outcome colitis-associated rectal cancer versus sporadic cancer.
abstract: The surgical management of colitis-associated rectal cancer (CARC) is not well defined. This study determines outcomes after surgery for CARC compared with sporadic rectal cancer.
  
  
  
  This is a retrospective cohort study comparing 27 patients with CARC with 54 matched patients with sporadic cancer. Matching criteria included age, gender, neoadjuvant chemoradiation, and American Joint Committee on Cancer stage. Outcome measures were disease-free and overall survival, tumor characteristics, and postoperative morbidity.
  
  
  
  Compared to those with sporadic rectal cancer, patients with CARC underwent proctocolectomy more frequently (21 [78%] versus 6 [22%] P < 0.001) and were more likely to have mucinous tumors (11 [40.7%] versus 12 [22.3%] P = 0.03). Overall 3-y survival was significantly reduced in CARC patients compared with patients with sporadic rectal cancer. Those with CARC undergoing segmental proctectomy only demonstrated reduced overall and disease-free survival compared to patients with sporadic rectal cancer and to colitis patients undergoing proctocolectomy (P = 0.002).
  
  
  
  Patients with CARC undergoing proctectomy demonstrate reduced disease-free survival versus those undergoing proctocolectomy, and versus patients with sporadic rectal cancer undergoing proctectomy. These findings warrant further study and suggest that proctocolectomy should be considered the preferred surgical approach for CARC.
authors.affiliation: Section of Colon and Rectal Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Coen L
authors.initials: CL
authors.lastname: Klos
authors.affiliation: Section of Colon and Rectal Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Bashar
authors.initials: B
authors.lastname: Safar
authors.affiliation: Section of Colon and Rectal Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Wise
authors.affiliation: Section of Colon and Rectal Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Hunt
authors.affiliation: Section of Colon and Rectal Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Mutch
authors.affiliation: Section of Colon and Rectal Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Elisa H
authors.initials: EH
authors.lastname: Birnbaum
authors.affiliation: Section of Colon and Rectal Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri.
authors.forename: James W
authors.initials: JW
authors.lastname: Fleshman
authors.affiliation: Section of Colon and Rectal Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri. Electronic address: dharmarajans@wudosis.wustl.edu.
authors.forename: Sekhar
authors.initials: S
authors.lastname: Dharmarajan
mesh_terms: D000230:Adenocarcinoma / Q000209:etiology / Q000601:surgery*; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003093:Colitis, Ulcerative / Q000150:complications*; D003424:Crohn Disease / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D016737:Proctocolectomy, Restorative; D012004:Rectal Neoplasms / Q000209:etiology / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Colitis; Inflammatory bowel disease; Proctectomy; Proctocolectomy; Rectal cancer