Risk of Rectal Neoplasia after Colectomy and Ileorectal Anastomosis for Ulcerative Colitis.
OBJECTIVE
Colectomy can be required in the management of ulcerative colitis [UC]. While ileal-pouch anal anastomosis [IPAA] is the recommended reconstruction technique, ileorectal anastomosis [IRA] is still performed and might present some advantages. However, the risk of rectal neoplasia might limit its indication. The aims of our study were to determine the incidence of rectal neoplasias following IRA for UC and to identify risk factors associated with rectal carcinomas.


METHODS
We performed a multicenter retrospective study including patients who underwent IRA for UC from 1960 to 2014 in 13 centers. Cox-proportional hazard models were used to determine carcinoma-associated risk factors.


RESULTS
A total of 343 patients were included, with a median follow-up of 10.4 years after IRA. At the end of follow-up, 38 rectal neoplasias (including 19 carcinomas) were diagnosed, and 7 patients [2%] had either died from rectal carcinoma or had a metastatic disease. Incidences of rectal carcinoma after IRA for UC were estimated at 3.2% at 10 years and at 7.3% at 20 years, whereas incidences of neoplasia were estimated at 7.1% and 14% at 10 and 20 years, respectively. In multivariate analysis, age at IRA, IBD duration, primary sclerosing cholangitis [PSC] and history of prior colonic carcinoma were independently associated with the risk of rectal carcinoma following IRA.


CONCLUSIONS
The risk of rectal carcinoma in patients with IRA for UC remains, and this justifies long-term endoscopic surveillance. Either IPAA or end ileostomy should be considered in 'high-risk' patients i.e. those with PSC and/or with prior colonic neoplasia.
Department of Gastroenterology, IBD and Nutritive Assistance, Hôpital Beaujon, APHP, Clichy, France.
Mathieu
M
Uzzan
Department of Gastroenterology, Hôpital Saint Antoine, APHP, Paris, France.
Julien
J
Kirchgesner
Department of Epidemiology and Clinical Research, Hôpital Beaujon, APHP, Clichy, France.
Nadia
N
Oubaya
Department of Gastroenterology, Hôpital Henri Mondor APHP, Créteil, France.
Aurélien
A
Amiot
Department of Gastroenterology, Hôpital Saint Louis, APHP, Paris, France.
Jean-Marc
JM
Gornet
Department of Gastroenterology, Hôpital Saint Antoine, APHP, Paris, France.
Philippe
P
Seksik
Department of Gastroenterology, CHU Lyon Sud, Pierre-Bénite, France.
Stéphane
S
Nancey
Department of Digestive Surgery, CHU Lyon Sud, Pierre-Bénite, France.
Eddy
E
Cotte
Department of Gastroenterology, Hôpital Saint Louis, APHP, Paris, France.
Matthieu
M
Allez
Department of Gastroenterology, CHU Lyon Sud, Pierre-Bénite, France.
Gilles
G
Boschetti
Department of Gastroenterology, Hôpital du Haut-Levêque, CHU Bordeaux, Pessac, France.
David
D
Laharie
Department of Digestive Surgery, Hôpital Henri Mondor, APHP, Créteil, France.
Nicola
N
de Angelis
Department of Gastroenterology, CHRU Lille, Lille, France.
Maria
M
Nachury
Department of Gastroenterology, Hôpital Xavier Bichat, APHP, Paris, France.
Anne-Laure
AL
Pelletier
Department of Gastroenterology, Hôpital Cochin, APHP, Paris, France.
Vered
V
Abitbol
Department of Gastroenterology, CHU Amiens, Amiens, France.
Mathurin
M
Fumery
Department of Digestive Surgery, Hôpital du Kremlin-Bicêtre, APHP, France.
Antoine
A
Brouquet
Department of Gastroenterology, CHU Estaing, Clermont-Ferrand, France.
Anthony
A
Buisson
Department of Gastroenterology, CHRU Montpellier, Montpellier, France.
Romain
R
Altwegg
Department of Gastroenterology, Hôpital Saint Antoine, APHP, Paris, France.
Jacques
J
Cosnes
Department of Digestive Surgery, Hôpital Beaujon, APHP, France.
Yves
Y
Panis
Department of Gastroenterology, IBD and Nutritive Assistance, Hôpital Beaujon, APHP, Clichy, France.
Xavier
X
Treton
D000328:Adult; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D003082:Colectomy / Q000009:adverse effects*; D003093:Colitis, Ulcerative / Q000601:surgery*; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012004:Rectal Neoplasms / Q000209:etiology*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult
Ulcerative colitis; ileorectal anastomosis; rectal carcinoma; rectal neoplasia