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Impact of Prostate Cancer Treatment on the Outcome of Ileal Pouch-Anal Anastomosis
Lei Lian*, Jean Ashburn, Feza H. Remzi, Bo Shen
Cleveland Clinic, Cleveland, OH
BACKGROUND: Prostate cancer can occur in patients with restorative proctocolectomy and ileal pouch-anal anastomosis (IPAA) for patients with refractory ulcerative colitis (UC) or colitis-associated neoplasia. Impact of prostate cancer treatment (prostatectomy and/or brachytherapy) on the ileal pouch function is not clear.
METHODS: All IPAA patients undergoing prostate cancer treatment were identified from our electronic medical record system with e-search. Pre-treatment and post-treatment pouch function and quality of life were compared.
RESULTS: A total of 30 consecutive, eligible patients were included, with a mean age of 62.5 ± 7.9 years. Ten (33.3%) patients had a family history of cancer. The underlying gastrointestinal diseases were UC (n = 27), colorectal cancer (n = 2), and familial adenomatous polyposis (n = 1). The ileal pouch was constructed prior to the diagnosis of prostate cancer in 24 (80%). Four patients (13.3/%) underwent pouch surgery after prostatectomy and 2 (6.7%) had synchronous prostatectomy and pouch construction. Treatment modalities of prostate cancer included prostatectomy without external bean radiation (n = 22), brachytherapy (n = 5), watchful waiting (n = 2), and hormonal therapy (n = 1). The median length of follow up was 6 years (1-15). Sixteen patients (53.3%) had complete data on pre- and post-treatment pouch function and pouch-related quality of life. No statistically significances were noticed in daytime bowel movements, nighttime bowel movements, Cleveland Clinic Global Quality of Life Score, daytime seepage, and nighttime seepage (Table). Pouch excision and permanent diversion were required in two patients who developed pouch failure, respectively.
CONCLUSION: Treatment for prostate cancer did not appear to have a negative impact on the pouch function and quality of life in patients with an ileal pouch-anal anastomosis.
Table. Comparison of pouch function and quality of life before and after treatment (N = 16)
| Variables | Before Treatment | After Treatment | P value | | Bowel movements during daytime | 5(3-12) | 6(2-12) | 0.65 | | Bowel movements at night | 2(0-6) | 3(0-10) | 0.13 | | Total bowel movements | 7(3-15) | 7(0-18) | 0.84 | | Current quality of life | 8(5-10) | 8(5-10) | 0.75 | | Current quality of health | 8(5-10) | 8(1-10) | 0.32 | | Current energy level | 8(1-10) | 8(3-10) | 0.81 | | CGQL | 0.8(0.4-1) | 0.8(0.43-1) | 0.44 | | Nighttime seepage | 10(62.5%) | 9(56.2%) | 1 | | Daytime seepage | 8(50%) | 7(43.8%) | 1 |
CGQL: Cleveland Clinic Global Quality of Life Score; Numbers are medians with ranges in parentheses.
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