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Clin Colon Rectal Surg 2024; 37(01): 022-029
DOI: 10.1055/s-0043-1762560
Review Article

Focal Cancer in Colitis

Cyrena C. Lam
1   Department of Colon and Rectal Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana
,
William Kethman
1   Department of Colon and Rectal Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana
› Author Affiliations Funding None.
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Abstract

Colorectal cancer (CRC) is a known complication of inflammatory bowel disease (IBD). Widely accepted guidelines recommend that patients with ulcerative colitis diagnosed with CRC undergo total proctocolectomy with or without ileal pouch-anal anastomosis, and that patients with Crohn's disease and CRC undergo either total colectomy or proctocolectomy. These approaches are ideal for preventing synchronous and metachronous cancer, minimizing risk of refractory colitis requiring reoperation, and is the appropriate treatment for the vast majority of patients with IBD who are diagnosed with CRC and require surgical intervention. Segmental colectomy, however, may be considered in select patients with IBD and CRC, specifically in elderly patients with short disease duration, in patients with mild colitis identified preoperatively, in patients with high operative risk and prohibitive comorbidities, and in patients whose CRC appears to be sporadic as opposed to colitis-associated. Patients undergoing segmental resection must be closely surveilled postoperatively for dysplasia, recurrent cancer, and refractory colitis.

Keywords

inflammatory bowel disease - colorectal cancer - synchronous cancer - metachronous cancer - segmental colectomy


Publication History

Article published online:
15 March 2023

© 2023. Thieme. All rights reserved.

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