In ulcerative colitis, total proctocolectomy is the treatment of choice for patients with colonic dysplasia or cancer because of the high risk for metachronous neoplasia. It is unknown whether patients with Crohn's disease and colon cancer or dysplasia have a similar risk.
We retrospectively reviewed the charts of 75 patients treated at our center from 2001 to 2011 with Crohn's disease and colon cancer who underwent segmental resection or subtotal colectomy (STC). We then identified the presence or absence of subsequent colon cancer or dysplasia in these patients during the follow-up (0–19 years).
Of the 64 patients with colon cancer, 25 had at least 1 metachronous cancer (39%). The mean time to a new cancer was 6.8 years. Eighty-five percent of patients (21/25) were undergoing annual screening colonoscopy. Of the 11 patients with dysplasia, 5 (46%) had a new dysplasia. Mean time to a new dysplastic lesion was 5.0 years. Nineteen of the 47 patients (40%) who had a segmental resection for colon cancer developed metachronous cancer and 6/17 patients (35%) with a STC had metachronous cancer. Two of the 4 patients (50%) with STC for dysplasia (50%) had a new dysplasia and 3/7 patients (43%) with segmental resection had a new dysplasia. There was no significant difference (P = 0.61) between recurrence rates in patients with segmental resection versus STC.
The high rate of metachronous colon cancer after surgical resection suggests that total proctocolectomy should be considered. Larger studies are required to determine if the same is true for dysplasia.
Article first published online 10 May 2013
*The Henry D. Janowitz Division of Gastroenterology, Department of Medicine;
†Department of Surgery, Division of Colorectal Surgery;
‡Department of Pathology; and
§Department of Surgery, Division of Colorectal Surgery, The Mount Sinai Hospital, New York, New York.
Reprints: Elana A. Maser, MD, FRCPC, The Henry D. Janowitz Division of Gastroenterology, Department of Medicine, The Mount Sinai Hospital, One Gustave L. Levy Place, Box 1069, New York, NY 10029 (e-mail: firstname.lastname@example.org).
The authors have no conflicts of interest to disclose.
Supported in part by The Burrill B. Crohn Research Foundation and in part by the Manhattan Surgical Research Foundation.
Received December 21, 2012
Accepted January 24, 2013