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Clinical Features and Outcomes in Patients With Ulcerative Colitis and Cancer: A Single Centre Experience
Vivek Mangla*, Anila T, Shailendra Lalwani, Naimish N. Mehta, Samiran Nundy
Surgical gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India, New Delhi, India
Background and Aims: The risk of developing colorectal cancer (CRC) is known to be significantly increased in patients with ulcerative colitis. We analysed our experience of their clinical features and results of surgical management from retrospectively collected data.
Results: Out of 170 patients who had undergone operations for ulcerative colitis during the period from 1996-2015, 10 had associated cancer. There were 4 females and 6 males with a mean age of 48.6 years (32-70 years), while the mean age in patients without cancer was 38.8.years. The average duration of UC to development of cancer was 14.5 years (6-30 years) and average duration of UC and surgery in non malignant cases is 3.25 years. All the patients were on treatment with either mesacol or steroids or both during the course of illness. None of the patients had a positive family history. Rectal bleeding was the most common presentation in 8 (80%) and 6 (60%) either pain or alteration in bowel habits, 1 (10%) presented with obstruction. Similar results were found in non malignant cases. Preoperative surveillance colonoscopy was done in all patients and preoperative diagnosis of cancer was made in 4 patients (2 mass, 1 polyp, 1 stricture). Incidental cancer was found in the rest of the patients. None had associated PSC and none received neoadjuvant chemoradiotherapy. The most common indication for operation was refractory disease in 5 patients (50%), 4(40%) had a preoperative diagnosis of cancer and 1 (10%) had obstruction. In non malignant patients steroid resistant disease(55%) was the most common indication, followed by steroid dependent disease. 4 patients (40%) had tumours in the sigmoid colon, 3(30%) in the rectum, 2 (20%) in the right colon and 1(10%) in the rectosigmoid region. 4 patients(40%) underwent total proct0colectomy with a pouch, 4 (40%) had total proctocolectomy with end ileostomy and 2 (20%) had total abdominal colectomy. 5 patients (50%) had well differentiated, 2 (20%) moderately differentiated, 1 (10%) poorly differentiated, 1 (10%) carcinoid and 1 (10%) an in situ lesion. Mean hospital stay was 12.7 days (8-17 days). Two (20%) patients had Stage I, 1 had IIb, 2 had IIIa, 2 had IIIb and 3 had IIIc disease. The 1-year disease free survival is 100%.
Conclusions: Colorectal malignancy in the setting of ulcerative colitis is relatively rare in India, presents at an early age and associated with a good outcome.
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