J Pouch Excision due to Pouch Neoplasia after Ileal Pouch Anal Anastomosis in Ulcerative Colitis Patients. Analysis of Nine Pouch Neoplasia Patients and Review of the Literature

Adam Bobkiewicz, Maciej Borejsza-Wysocki, Maciej Konopka, Tomasz Banasiewicz and Lukasz Krokowicz*

Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Poland

^*Correspondance to: Lukasz Krokowicz 

 PDF  Full Text DOI: 10.25107/2474-1647.3051

Abstract

Purpose: Ileal Pouch-Anal Anastomosis (IPAA) is the procedure of choice in Ulcerative Colitis (UC) patients or Familial Adenomatous Polyposis (FAP). Pouch neoplasia is a rare long-term pouch complication. We present an analysis of nine patients after pouch excision due to the pouch dysplasia or cancer. Methods: Retrospectively patients who underwent IPAA between 1985 and 2009 were analyzed. Data of patients qualified for pouch excision were analyzed such as: gender, age, duration of UC before IPAA, presence of neoplasia in the colectomy specimen the location of the pouch neoplasia and others. Patient was qualified for pouch excision based on histopathological examination, endoscopic and imaging studies and clinical evaluation. Abdominoperineal resection in association with pouch excision with permanent ileostomy was the standard management in diagnosis of pouch neoplasia. Results: A total of 276 patients who underwent the IPAA procedure were analyzed. Nine patients developed pouch neoplasia. The mean age at the time of pouch excision was 46.2 ? 7.9 years (range: 38 to 62 years). The mean duration of ulcerative colitis prior to IPAA was 18.8 ? 7.9 years (range: 2 to 28), while the time between IPAA and pouch neoplasia was 13.2 ? 5.8 (range: 5 to 20). Seven patients diagnosed with pouch neoplasia had showed neoplasia in the colorectal specimen. Abdominoperineal resection in association with pouch excision with permanent ileostomy was performed in nine patients. There were no major postoperative complications. Conclusion: The prevalence of neoplasia in the pouch is rare. Strict postoperative endoscopic surveillance in this group of patients may allow for early stage detection of neoplastic changes. It is highly important to create IPAA patient databases in order to monitor the effectiveness of treatment

Keywords

Pouch neoplasia; Pouch excision; Restorative proctocolectomy; Ulcerative colitis

Cite the article

Bobkiewicz A, Borejsza-Wysocki M, Konopka M, Banasiewicz T, Krokowicz L. J Pouch Excision due to Pouch Neoplasia after Ileal Pouch Anal Anastomosis in Ulcerative Colitis Patients. Analysis of Nine Pouch Neoplasia Patients and Review of the Literature. Clin Surg. 2021; 6: 3051..