TY - JOUR
T1 - Long-term Risk of Cancer Following Ileal Pouch-anal Anastomosis for Ulcerative Colitis
AU - Mark-Christensen, Anders
AU - Erichsen, Rune
AU - Brandsborg, Søren
AU - Rosenberg, Jacob
AU - Qvist, Niels
AU - Thorlacius-Ussing, Ole
AU - Hillingsø, Jens
AU - Pachler, Jørn Helmut
AU - Christiansen, Erica Gould
AU - Laurberg, Søren
N1 - Copyright © 2017 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com
PY - 2018
Y1 - 2018
N2 - Background: The overall risk of cancer following ileal pouch-anal anastomosis [IPAA] is unknown, and pouch cancer surveillance is controversial. We evaluated long-term risk of cancer in a national cohort of patients with ulcerative colitis and IPAA, with emphasis on pouch cancer.Methods: Data on incident cancers were extracted from the national Danish Cancer Registry. Incidence rates for all site-specific cancers were compared between patients with IPAA and a gender- and age-matched comparison cohort from the background population to obtain incidence rate ratios [IRRs].Results: A total of 1723 patients with IPAA, operated for ulcerative colitis in the period 1980-2010, were matched to 8615 individuals from the background population. During a median follow-up of 12.9 years (interquartile range [IQR] 7.7-19.6 years), two pouch cancers [0.12%] were found after 16 and 27 years, respectively. In the population comparison cohort, 38 intestinal cancers [0.45%] were found, of which 35 were colorectal. The risk of hepatobiliary cancer was higher for patients with IPAA {IRR = 13.0 (95% confidence interval [CI]: 3.1-76.1)}, and half of the affected patients had coexisting primary sclerosing cholangitis. The risk of cancer overall following IPAA was identical to that of the comparison cohort: IRR = 1.05 [0.84-1.31].Conclusions: Pouch cancer following IPAA is very rare, questioning the need for general, rather than selective, surveillance. The overall cancer risk is comparable to that of the background population, and the increased risk of hepatobiliary cancer is likely an effect of coexisting liver disease and not causally related to IPAA.
AB - Background: The overall risk of cancer following ileal pouch-anal anastomosis [IPAA] is unknown, and pouch cancer surveillance is controversial. We evaluated long-term risk of cancer in a national cohort of patients with ulcerative colitis and IPAA, with emphasis on pouch cancer.Methods: Data on incident cancers were extracted from the national Danish Cancer Registry. Incidence rates for all site-specific cancers were compared between patients with IPAA and a gender- and age-matched comparison cohort from the background population to obtain incidence rate ratios [IRRs].Results: A total of 1723 patients with IPAA, operated for ulcerative colitis in the period 1980-2010, were matched to 8615 individuals from the background population. During a median follow-up of 12.9 years (interquartile range [IQR] 7.7-19.6 years), two pouch cancers [0.12%] were found after 16 and 27 years, respectively. In the population comparison cohort, 38 intestinal cancers [0.45%] were found, of which 35 were colorectal. The risk of hepatobiliary cancer was higher for patients with IPAA {IRR = 13.0 (95% confidence interval [CI]: 3.1-76.1)}, and half of the affected patients had coexisting primary sclerosing cholangitis. The risk of cancer overall following IPAA was identical to that of the comparison cohort: IRR = 1.05 [0.84-1.31].Conclusions: Pouch cancer following IPAA is very rare, questioning the need for general, rather than selective, surveillance. The overall cancer risk is comparable to that of the background population, and the increased risk of hepatobiliary cancer is likely an effect of coexisting liver disease and not causally related to IPAA.
KW - Journal Article
KW - Cancer
KW - Ileal pouch-anal anastomosis
KW - Ulcerative colitis
KW - Colorectal Neoplasms/epidemiology
KW - Follow-Up Studies
KW - Biliary Tract Neoplasms/epidemiology
KW - Humans
KW - Liver Neoplasms/epidemiology
KW - Colonic Pouches/pathology
KW - Male
KW - Case-Control Studies
KW - Incidence
KW - Young Adult
KW - Denmark/epidemiology
KW - Time Factors
KW - Adult
KW - Female
KW - Registries
KW - Cholangitis, Sclerosing/complications
KW - Proctocolectomy, Restorative
KW - Colitis, Ulcerative/complications
UR - http://www.scopus.com/inward/record.url?scp=85040591302&partnerID=8YFLogxK
U2 - 10.1093/ecco-jcc/jjx112
DO - 10.1093/ecco-jcc/jjx112
M3 - Journal article
C2 - 28981638
SN - 1873-9946
VL - 12
SP - 57
EP - 62
JO - Journal of Crohn's and Colitis
JF - Journal of Crohn's and Colitis
IS - 1
ER -