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Surveillance Colonoscopy for Ulcerative Colitis-Associated Colorectal Cancer Offers Better Overall Survival in Real-World Surgically Resected Cases

Hata, Keisuke, MD, PhD1; Anzai, Hiroyuki, MD, PhD1; Ikeuchi, Hiroki, MD, PhD2; Futami, Kitaro, MD, PhD3; Fukushima, Kouhei, MD, PhD4,5; Sugita, Akira, MD, PhD6; Uchino, Motoi, MD, PhD2; Higashi, Daijiro, MD, PhD3; Itabashi, Michio, MD, PhD7; Watanabe, Kazuhiro, MD, PhD8; Koganei, Kazutaka, MD, PhD6; Araki, Toshimitsu, MD, PhD9; Kimura, Hideaki, MD, PhD10; Mizushima, Tsunekazu, MD, PhD11; Ueda, Takeshi, MD, PhD12; Ishihara, Soichiro, MD, PhD1; Suzuki, Yasuo, MD, PhD13 on behalf of the Research Group for Intractable Inflammatory Bowel Disease of the Ministry of Health, Labour and Welfare of Japan (RGIBD)

American Journal of Gastroenterology: March 2019 - Volume 114 - Issue 3 - p 483–489
doi: 10.14309/ajg.0000000000000117

OBJECTIVES: To determine the effectiveness of surveillance colonoscopy (SC) and optimize its use by assessing real-world surgically resected cases of ulcerative colitis (UC)-associated colorectal cancer (CRC) and dysplasia.

METHODS: Clinicopathological data of 406 (238 CRC and 168 dysplasia) patients who underwent surgical resection in 10 UC specialized institutions were retrospectively reviewed. The overall survival (OS) rates were compared between the SC and non-SC groups. The incidence of and risk factors for early-onset CRC (<8 years after UC onset) were identified. The distribution of CRC lesions was also assessed.

RESULTS: Cancer stages were significantly more advanced in the non-SC group than in the SC group (P < 0.001). The patients in the SC group showed significantly better OS than those in the non-SC group (5-year OS: 89% vs 70%; log-rank test: P = 0.001). Seventeen percent of patients developed CRC within 8 years after UC onset. The age at UC onset was a risk factor and a good predictor of early-onset CRC (<8 years) (P < 0.01; AUC: 0.85). The most common sites of CRC were the rectum (51%) and sigmoid colon (20%). Multiple CRC was identified in 16% of patients.

CONCLUSIONS: Surveillance colonoscopy was effective and improved the OS in patients with UC. We recommend that patients with late-onset UC (>40 years) undergo SCs earlier because of the high incidence of CRC within 8 years of UC onset. Moreover, the rectum and sigmoid colon should be more thoroughly examined.

1Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan;

2Department of Inflammatory Bowel Disease Surgery, Hyogo College of Medicine, Nishinomiya, Japan;

3Department of Surgery, Fukuoka University Chikushi Hospital, Chikushino, Japan;

4Division of Surgical and Molecular Pathophysiology, Tohoku University, Graduate School of Medicine, Sendai, Japan;

5Laboratory of Gastrointestinal Reconstruction, Tohoku University, Graduate School of Biomedical Engineering, Sendai, Japan;

6Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, Yokohama, Japan;

7Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan;

8Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan;

9Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences Mie University Graduate School of Medicine;

10Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan;

11Department of Gastroenterological Surgery/Therapeutics for Inflammatory Bowel Diseases, Osaka University Graduate School of Medicine, Osaka, Japan;

12Department of Surgery, Nara Medical University, Kashihara, Japan;

13Internal Medicine, Sakura Medical Center, Toho University, Tokyo, Japan.

Correspondence: Keisuke Hata, MD, PhD. E-mail:

SUPPLEMENTARY MATERIAL accompanies this paper at

Received May 21, 2018

Accepted November 29, 2018

© The American College of Gastroenterology 2019. All Rights Reserved.
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