Malignant and Nonmalignant Complications of the Rectal Stump in Patients with Inflammatory Bowel Disease

Autor: Sebastiaan A.C. van Tuyl, Miangela M. Lacle, Bas Oldenburg, Lauranne A A P Derikx, Michiel T J Bak, Joren R. ten Hove, Nofel Mahmmod, Jonathan M K Bogaerts, Vincent Meij, Frank Hoentjen
Rok vydání: 2019
Předmět:
Adult
Male
medicine.medical_specialty
medicine.medical_treatment
Rectum
digestive system
Inflammatory bowel disease
03 medical and health sciences
Ileostomy
Postoperative Complications
0302 clinical medicine
dysplasia
medicine
Humans
cancer
Immunology and Allergy
Proctitis
Prospective Studies
Prospective cohort study
Survival rate
Colectomy
Netherlands
Retrospective Studies
Rectal Neoplasms
business.industry
Incidence
rectal stump
Gastroenterology
Inflammatory Bowel Diseases
Prognosis
medicine.disease
Surgery
Survival Rate
body regions
surgical procedures
operative
medicine.anatomical_structure
Dysplasia
030220 oncology & carcinogenesis
Quality of Life
Female
030211 gastroenterology & hepatology
business
Inflammatory diseases Radboud Institute for Molecular Life Sciences [Radboudumc 5]
Follow-Up Studies
Zdroj: Inflammatory Bowel Diseases, 25, 2, pp. 377-384
Inflammatory Bowel Diseases, 25, 377-384
Inflammatory bowel diseases, 25(2), 377. John Wiley and Sons Inc.
ISSN: 1078-0998
Popis: Contains fulltext : 205172.pdf (Publisher’s version ) (Closed access) Background: Patients with refractory inflammatory bowel disease (IBD) might require a subtotal colectomy with construction of an ileostomy. Due to the risk of nerve damage and pelvic sepsis, the diverted rectum is often left in situ. Evidence on long-term complications of this rectal stump is limited, particularly in patients with Crohn's disease (CD). In addition to the risk of development of neoplasia, diversion proctitis is a frequently reported rectal stump associated complication. Surprisingly, clear recommendations concerning rectal stump surveillance and timing of proctectomy are lacking. Methods: Through the use of a pathology database and a review of medical records, we established a cohort of IBD patients with a diverted rectum. Among these patients, long-term complications of the rectal stump were identified. Main endpoint was advanced neoplasia (carcinoma or high-grade dysplasia [HGD]) in the rectal stump. Risk factors for advanced neoplasia were identified using Cox regression modeling. In the second, prospective part of the study, a questionnaire was sent out to 165 patients with either a rectal stump in situ or who had undergone a proctectomy, in order to identify differences in patient-reported outcome measures associated with the excision of the rectal stump. Results: From 530 patients with IBD and a (temporal) diversion of the rectum, we included 250 patients in whom the rectal stump was left in situ for more than 12 months. The majority of patients was female (61%) and had Crohn's disease (67%). On follow-up (median 8 years), 8 carcinomas, 2 cases of high-grade dysplasia, and 7 cases of low-grade dysplasia were found with incidence rates of 3.9 and 8.5 per 1000 patient-years of follow-up for cancer and all neoplasia, respectively. The 8 cases of rectal stump cancer (RSC) were diagnosed after a median of 15 years after colectomy. A history of colorectal neoplasia was associated with advanced rectal stump neoplasia. Out of 191 patients with endoscopic follow-up, rectal stump inflammation occurred in 161 (88.5%) patients. Results of the questionnaire did not show a significant difference in quality of life between patients with and patients without a rectal stump, although the latter group reported significantly more sexual and urinary symptoms than patients with a rectal stump in situ. The majority of rectal stump patients reported rectal blood loss, but 65.5% of them were not or barely limited in daily life by their rectal stumprelated problems. Conclusion: Rectal stump cancer has a low incidence rate, with patients with a history of colonic neoplasia carrying the highest risk of developing this severe complication. We observed no significant differences in quality of life between rectal stump and postproctectomy patients, but proctectomy surgery is associated with sexual and urinary complications.
Databáze: OpenAIRE
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