PMID- 16919105
OWN - NLM
STAT- MEDLINE
DCOM- 20061212
LR  - 20060821
IS  - 1462-8910 (Print)
IS  - 1462-8910 (Linking)
VI  - 8
IP  - 7
DP  - 2006 Sep
TI  - Surgery for neoplastic changes in ulcerative colitis--can limited resection be 
      justified? Outcome for patients who underwent limited surgery.
PG  - 551-6
AB  - BACKGROUND: Patients with ulcerative colitis (UC) are at an increased risk of 
      developing colorectal cancer (CRC). The aim of this study was to investigate the 
      outcome for the patients who underwent limited resection of the colon and/or 
      rectum instead of panproctocolectomy (PPC), with special attention to those with 
      neoplastic changes. METHODS: Since 1977, all known patients with UC from our 
      catchment area have been included in our surveillance programme. A total of 210 
      patients with UC have been followed up with regular colonoscopies and biopsies. 
      Indications for surgery were severe therapy-resistant disease (TRD), high-grade 
      dysplasia (HGD), CRC or repeated findings of low-grade dysplasia (LGD). Patient 
      compliance was excellent. RESULTS: Fifty-one patients were operated on. In 29 of 
      these patients, PPC was performed initially. At the end-point of the study, 
      additionally seven patients had been radically operated on and three more 
      patients planned to undergo such an operation. Accordingly, 22 patients had their 
      first operation performed as a resection of either a part of or the whole colon 
      or rectum. In this group, there were four patients diagnosed with CRC and three 
      with dysplasia-associated lesion or mass (DALM). One of them died 6 months after 
      surgery because of disseminated CRC, whereas the other patients were alive at the 
      end-point of the study. One of these seven patients with CRC or DALM had at 
      end-point been radically operated on and two patients were awaiting such a 
      procedure (in two patients because of LGD and in one patient because of TRD). Six 
      of the patients who had a colorectal resection performed on the indication of TRD 
      were radically operated later on, five of them because of relapsed TRD and one 
      patient because of LGD in the remaining rectal mucosa. Twenty-one patients gained 
      a mean of 9.4 years with presumably better bowel function, from undergoing a 
      limited resection instead of PPC. None of the patients who underwent a colonic 
      and/or rectal resection died because of CRC or metachronous cancer in their 
      remaining colon or rectum. CONCLUSION: The results of this study indicate that a 
      limited resection of the colon and/or rectum in patients with UC, which requires 
      surgical intervention increases the time with presumably better bowel function 
      and may therefore be an alternative to PPC without increased risk of dying from 
      CRC. This is dependent on the flexibility of the medical service and patient 
      compliance.
FAU - Lindberg, J
AU  - Lindberg J
AD  - Department of Surgery, Ornskoldsvik Hospital, Ornskoldsvik, Sweden. 
      jan.lindberg@lvn.se
FAU - Stenling, R
AU  - Stenling R
FAU - Palmqvist, R
AU  - Palmqvist R
FAU - Rutegard, J
AU  - Rutegard J
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - Colorectal Dis
JT  - Colorectal disease : the official journal of the Association of Coloproctology of 
      Great Britain and Ireland
JID - 100883611
SB  - IM
CIN - Colorectal Dis. 2006 Sep;8(7):537-8. PMID: 16919102
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Child
MH  - Child, Preschool
MH  - Colitis, Ulcerative/*complications/mortality/*pathology/surgery
MH  - Female
MH  - Humans
MH  - Intestinal Mucosa/pathology
MH  - Male
MH  - Middle Aged
MH  - Population Surveillance
MH  - Treatment Outcome
EDAT- 2006/08/22 09:00
MHDA- 2006/12/13 09:00
CRDT- 2006/08/22 09:00
PHST- 2006/08/22 09:00 [pubmed]
PHST- 2006/12/13 09:00 [medline]
PHST- 2006/08/22 09:00 [entrez]
AID - CDI997 [pii]
AID - 10.1111/j.1463-1318.2006.00997.x [doi]
PST - ppublish
SO  - Colorectal Dis. 2006 Sep;8(7):551-6. doi: 10.1111/j.1463-1318.2006.00997.x.