Download PDF
Clin Colon Rectal Surg 2024; 37(01): 037-040
DOI: 10.1055/s-0043-1762562
Review Article

Cancer in the Anal Transition Zone and Ileoanal Pouch following Surgery for Ulcerative Colitis

Jennifer L. Miller-Ocuin
1   Division of Colorectal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
2   Department of Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
,
Jean H. Ashburn
2   Department of Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Restorative proctocolectomy with ileal pouch-anal anastomosis remains the gold standard treatment for patients with ulcerative colitis who desire restoration of intestinal continuity. Despite a significant cancer risk reduction after surgical removal of the colon and rectum, dysplasia and cancers of the ileal pouch or anal transition zone still occur and are a risk even if an anal canal mucosectomy is performed. Surgical care and maintenance after ileoanal anastomosis must include consideration of malignant potential along with other commonly monitored variables such as bowel function and quality of life. Cancers and dysplasia of the ileal pouch are rare but sometimes difficult-to-manage sequelae of pouch surgery.

Keywords

ileoanal pouch - anal transition zone - dysplasia - ulcerative colitis - pouch cancer - anal neoplasia


Publication History

Article published online:
24 March 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Reichman HR. Indications for surgical treatment of chronic idiopathic ulcerative colitis. Proc R Soc Med 1959; 52 (suppl 1): 15-16
    PubMedSearch in Google Scholar
  • 2 Devine J, Webb R. Resection of the rectal mucosa, colectomy, and anal ileostomy with normal continence. Surg Gynecol Obstet 1951; 92 (04) 437-442
    PubMedSearch in Google Scholar
  • 3 Peck DA, German JD, Jackson FC. Rectal resection for benign disease: a new technic. Dis Colon Rectum 1966; 9 (05) 363-366
    CrossrefPubMedSearch in Google Scholar
  • 4 Parks AG, Nicholls RJ. Proctocolectomy without ileostomy for ulcerative colitis. BMJ 1978; 2 (6130): 85-88
    CrossrefPubMedSearch in Google Scholar
  • 5 Utsunomiya J, Iwama T, Imajo M. et al. Total colectomy, mucosal proctectomy, and ileoanal anastomosis. Dis Colon Rectum 1980; 23 (07) 459-466
    CrossrefPubMedSearch in Google Scholar
  • 6 Fazio VW, O'Riordain MG, Lavery IC. et al. Long-term functional outcome and quality of life after stapled restorative proctocolectomy. Ann Surg 1999; 230 (04) 575-584 , discussion 584–586
    CrossrefPubMedSearch in Google Scholar
  • 7 Heald RJ, Allen DR. Stapled ileo-anal anastomosis: a technique to avoid mucosal proctectomy in the ileal pouch operation. Br J Surg 1986; 73 (07) 571-572
    CrossrefPubMedSearch in Google Scholar
  • 8 Lovegrove RE, Constantinides VA, Heriot AG. et al. A comparison of hand-sewn versus stapled ileal pouch anal anastomosis (IPAA) following proctocolectomy: a meta-analysis of 4183 patients. Ann Surg 2006; 244 (01) 18-26
    CrossrefPubMedSearch in Google Scholar
  • 9 Kirat HT, Remzi FH, Kiran RP, Fazio VW. Comparison of outcomes after hand-sewn versus stapled ileal pouch-anal anastomosis in 3,109 patients. Surgery 2009; 146 (04) 723-729 , discussion 729–730
    CrossrefPubMedSearch in Google Scholar
  • 10 Remzi FH, Fazio VW, Delaney CP. et al. Dysplasia of the anal transitional zone after ileal pouch-anal anastomosis: results of prospective evaluation after a minimum of ten years. Dis Colon Rectum 2003; 46 (01) 6-13
    CrossrefPubMedSearch in Google Scholar
  • 11 Thompson-Fawcett MW, Mortensen NJ. Anal transitional zone and columnar cuff in restorative proctocolectomy. Br J Surg 1996; 83 (08) 1047-1055
    CrossrefPubMedSearch in Google Scholar
  • 12 Holder-Murray J, Fichera A. Anal transition zone in the surgical management of ulcerative colitis. World J Gastroenterol 2009; 15 (07) 769-773
    CrossrefPubMedSearch in Google Scholar
  • 13 Régimbeau JM, Panis Y, Pocard M, Hautefeuille P, Valleur P. Handsewn ileal pouch-anal anastomosis on the dentate line after total proctectomy: technique to avoid incomplete mucosectomy and the need for long-term follow-up of the anal transition zone. Dis Colon Rectum 2001; 44 (01) 43-50 , discussion 50–51
    CrossrefPubMedSearch in Google Scholar
  • 14 Heppell J, Weiland LH, Perrault J, Pemberton JH, Telander RL, Beart Jr RW. Fate of the rectal mucosa after rectal mucosectomy and ileoanal anastomosis. Dis Colon Rectum 1983; 26 (12) 768-771
    CrossrefPubMedSearch in Google Scholar
  • 15 O'Connell PR, Pemberton JH, Kelly KA. Motor function of the ileal J pouch and its relation to clinical outcome after ileal pouch-anal anastomosis. World J Surg 1987; 11 (06) 735-741
    CrossrefPubMedSearch in Google Scholar
  • 16 O'Riordan JM, Kirsch R, Mohseni M, McLeod RS, Cohen Z. Long-term risk of adenocarcinoma post-ileal pouch-anal anastomosis for ulcerative colitis: report of two cases and review of the literature. Int J Colorectal Dis 2012; 27 (03) 405-410
    CrossrefPubMedSearch in Google Scholar
  • 17 M'Koma AE, Moses HL, Adunyah SE. Inflammatory bowel disease-associated colorectal cancer: proctocolectomy and mucosectomy do not necessarily eliminate pouch-related cancer incidences. Int J Colorectal Dis 2011; 26 (05) 533-552
    CrossrefPubMedSearch in Google Scholar
  • 18 Kirat HT, Remzi FH. Technical aspects of ileoanal pouch surgery in patients with ulcerative colitis. Clin Colon Rectal Surg 2010; 23 (04) 239-247
    Thieme ConnectPubMedSearch in Google Scholar
  • 19 Shen B, Kochhar GS, Kariv R. et al. Diagnosis and classification of ileal pouch disorders: consensus guidelines from the International Ileal Pouch Consortium. Lancet Gastroenterol Hepatol 2021; 6 (10) 826-849
    CrossrefPubMedSearch in Google Scholar
  • 20 Le Cosquer G, Buscail E, Gilletta C. et al. Incidence and risk factors of cancer in the anal transitional zone and ileal pouch following surgery for ulcerative colitis and familial adenomatous polyposis. Cancers (Basel) 2022; 14 (03) 530
    CrossrefPubMedSearch in Google Scholar
  • 21 Scarpa M, van Koperen PJ, Ubbink DT, Hommes DW, Ten Kate FJ, Bemelman WA. Systematic review of dysplasia after restorative proctocolectomy for ulcerative colitis. Br J Surg 2007; 94 (05) 534-545
    CrossrefPubMedSearch in Google Scholar
  • 22 Selvaggi F, Pellino G, Canonico S, Sciaudone G. Systematic review of cuff and pouch cancer in patients with ileal pelvic pouch for ulcerative colitis. Inflamm Bowel Dis 2014; 20 (07) 1296-1308
    CrossrefPubMedSearch in Google Scholar
  • 23 Pellino G, Kontovounisios C, Tait D, Nicholls J, Tekkis PP. Squamous cell carcinoma of the anal transitional zone after ileal pouch surgery for ulcerative colitis: systematic review and treatment perspectives. Case Rep Oncol 2017; 10 (01) 112-122
    CrossrefPubMedSearch in Google Scholar
  • 24 Kariv R, Remzi FH, Lian L. et al. Preoperative colorectal neoplasia increases risk for pouch neoplasia in patients with restorative proctocolectomy. Gastroenterology 2010; 139 (03) 806-812 , 812.e1–812.e2
    CrossrefPubMedSearch in Google Scholar
  • 25 Ståhlberg D, Veress B, Tribukait B, Broomé U. Atrophy and neoplastic transformation of the ileal pouch mucosa in patients with ulcerative colitis and primary sclerosing cholangitis: a case control study. Dis Colon Rectum 2003; 46 (06) 770-778
    CrossrefPubMedSearch in Google Scholar
  • 26 Veress B, Löfberg R, Bergman L. Microscopic colitis syndrome. Gut 1995; 36 (06) 880-886
    CrossrefPubMedSearch in Google Scholar
  • 27 Kuisma J, Mentula S, Luukkonen P, Jarvinen H, Kahri A, Farkkila M. Factors associated with ileal mucosal morphology and inflammation in patients with ileal pouch-anal anastomosis for ulcerative colitis. Dis Colon Rectum 2003; 46 (11) 1476-1483
    CrossrefPubMedSearch in Google Scholar
  • 28 Duffy M, O'Mahony L, Coffey JC. et al. Sulfate-reducing bacteria colonize pouches formed for ulcerative colitis but not for familial adenomatous polyposis. Dis Colon Rectum 2002; 45 (03) 384-388
    CrossrefPubMedSearch in Google Scholar
  • 29 Derikx LA, Nissen LH, Oldenburg B, Hoentjen F. Controversies in pouch surveillance for patients with inflammatory bowel disease. J Crohn's Colitis 2016; 10 (06) 747-751
    CrossrefPubMedSearch in Google Scholar
  • 30 Gu J, Remzi FH, Lian L, Shen B. Practice pattern of ileal pouch surveillance in academic medical centers in the United States. Gastroenterol Rep (Oxf) 2016; 4 (02) 119-124
    CrossrefPubMedSearch in Google Scholar
  • 31 Ault GT, Nunoo-Mensah JW, Johnson L, Vukasin P, Kaiser A, Beart Jr RW. Adenocarcinoma arising in the middle of ileoanal pouches: report of five cases. Dis Colon Rectum 2009; 52 (03) 538-541
    CrossrefPubMedSearch in Google Scholar
  • 32 Pedersen ME, Rahr HB, Fenger C, Qvist N. Adenocarcinoma arising from the rectal stump eleven years after excision of an ileal J-pouch in a patient with ulcerative colitis: report of a case. Dis Colon Rectum 2008; 51 (07) 1146-1148
    CrossrefPubMedSearch in Google Scholar
  • 33 Aytac E, Ashburn J, Dietz DW. Is there still a role for continent ileostomy in the surgical treatment of inflammatory bowel disease?. Inflamm Bowel Dis 2014; 20 (12) 2519-2525
    CrossrefPubMedSearch in Google Scholar
  • 34 Aytac E, Dietz DW, Ashburn J, Remzi FH. Is conversion of a failed IPAA to a continent ileostomy a risk factor for long-term failure?. Dis Colon Rectum 2019; 62 (02) 217-222
    CrossrefPubMedSearch in Google Scholar