High rates of metachronous colon cancer or dysplasia after segmental resection or subtotal colectomy in Crohn's colitis

Elana A. Maser, David B. Sachar, Danielle Kruse, Noam Harpaz, Thomas A. Ullman, Joel J. Bauer

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background: In ulcerative colitis, total proctocolectomy is the treatment of choice for patients with colonic dysplasia or cancer because of the high risk for metachronous neoplasia. It is unknown whether patients with Crohn's disease and colon cancer or dysplasia have a similar risk. Methods: We retrospectively reviewed the charts of 75 patients treated at our center from 2001 to 2011 with Crohn's disease and colon cancer who underwent segmental resection or subtotal colectomy (STC). We then identified the presence or absence of subsequent colon cancer or dysplasia in these patients during the follow-up (0-19 years). Results: Of the 64 patients with colon cancer, 25 had at least 1 metachronous cancer (39%). The mean time to a new cancer was 6.8 years. Eighty-five percent of patients (21/25) were undergoing annual screening colonoscopy. Of the 11 patients with dysplasia, 5 (46%) had a new dysplasia. Mean time to a new dysplastic lesion was 5.0 years. Nineteen of the 47 patients (40%) who had a segmental resection for colon cancer developed metachronous cancer and 6/17 patients (35%) with a STC had metachronous cancer. Two of the 4 patients (50%) with STC for dysplasia (50%) had a new dysplasia and 3/7 patients (43%) with segmental resection had a new dysplasia. There was no significant difference (P = 0.61) between recurrence rates in patients with segmental resection versus STC. Conclusions: The high rate of metachronous colon cancer after surgical resection suggests that total proctocolectomy should be considered. Larger studies are required to determine if the same is true for dysplasia.

Original languageEnglish (US)
Pages (from-to)1827-1832
Number of pages6
JournalInflammatory Bowel Diseases
Volume19
Issue number9
DOIs
StatePublished - Aug 1 2013
Externally publishedYes

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Colectomy
Colitis
Colonic Neoplasms
Neoplasms
Crohn Disease
Colonoscopy
Ulcerative Colitis

Keywords

  • Colon cancer
  • Inflammatory bowel disease
  • Screening
  • Surgery

ASJC Scopus subject areas

  • Immunology and Allergy
  • Gastroenterology

Cite this

High rates of metachronous colon cancer or dysplasia after segmental resection or subtotal colectomy in Crohn's colitis. / Maser, Elana A.; Sachar, David B.; Kruse, Danielle; Harpaz, Noam; Ullman, Thomas A.; Bauer, Joel J.

In: Inflammatory Bowel Diseases, Vol. 19, No. 9, 01.08.2013, p. 1827-1832.

Research output: Contribution to journalArticle

Maser, Elana A. ; Sachar, David B. ; Kruse, Danielle ; Harpaz, Noam ; Ullman, Thomas A. ; Bauer, Joel J. / High rates of metachronous colon cancer or dysplasia after segmental resection or subtotal colectomy in Crohn's colitis. In: Inflammatory Bowel Diseases. 2013 ; Vol. 19, No. 9. pp. 1827-1832.
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AU - Ullman, Thomas A.

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N2 - Background: In ulcerative colitis, total proctocolectomy is the treatment of choice for patients with colonic dysplasia or cancer because of the high risk for metachronous neoplasia. It is unknown whether patients with Crohn's disease and colon cancer or dysplasia have a similar risk. Methods: We retrospectively reviewed the charts of 75 patients treated at our center from 2001 to 2011 with Crohn's disease and colon cancer who underwent segmental resection or subtotal colectomy (STC). We then identified the presence or absence of subsequent colon cancer or dysplasia in these patients during the follow-up (0-19 years). Results: Of the 64 patients with colon cancer, 25 had at least 1 metachronous cancer (39%). The mean time to a new cancer was 6.8 years. Eighty-five percent of patients (21/25) were undergoing annual screening colonoscopy. Of the 11 patients with dysplasia, 5 (46%) had a new dysplasia. Mean time to a new dysplastic lesion was 5.0 years. Nineteen of the 47 patients (40%) who had a segmental resection for colon cancer developed metachronous cancer and 6/17 patients (35%) with a STC had metachronous cancer. Two of the 4 patients (50%) with STC for dysplasia (50%) had a new dysplasia and 3/7 patients (43%) with segmental resection had a new dysplasia. There was no significant difference (P = 0.61) between recurrence rates in patients with segmental resection versus STC. Conclusions: The high rate of metachronous colon cancer after surgical resection suggests that total proctocolectomy should be considered. Larger studies are required to determine if the same is true for dysplasia.

AB - Background: In ulcerative colitis, total proctocolectomy is the treatment of choice for patients with colonic dysplasia or cancer because of the high risk for metachronous neoplasia. It is unknown whether patients with Crohn's disease and colon cancer or dysplasia have a similar risk. Methods: We retrospectively reviewed the charts of 75 patients treated at our center from 2001 to 2011 with Crohn's disease and colon cancer who underwent segmental resection or subtotal colectomy (STC). We then identified the presence or absence of subsequent colon cancer or dysplasia in these patients during the follow-up (0-19 years). Results: Of the 64 patients with colon cancer, 25 had at least 1 metachronous cancer (39%). The mean time to a new cancer was 6.8 years. Eighty-five percent of patients (21/25) were undergoing annual screening colonoscopy. Of the 11 patients with dysplasia, 5 (46%) had a new dysplasia. Mean time to a new dysplastic lesion was 5.0 years. Nineteen of the 47 patients (40%) who had a segmental resection for colon cancer developed metachronous cancer and 6/17 patients (35%) with a STC had metachronous cancer. Two of the 4 patients (50%) with STC for dysplasia (50%) had a new dysplasia and 3/7 patients (43%) with segmental resection had a new dysplasia. There was no significant difference (P = 0.61) between recurrence rates in patients with segmental resection versus STC. Conclusions: The high rate of metachronous colon cancer after surgical resection suggests that total proctocolectomy should be considered. Larger studies are required to determine if the same is true for dysplasia.

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KW - Screening

KW - Surgery

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