Rectal Cancer Risk After Different Ulcerative Colitis Operations

Summary and Comment |
January 23, 2017

Rectal Cancer Risk After Different Ulcerative Colitis Operations

  1. Douglas K. Rex, MD

Ileal pouch anal anastomosis carries the lowest risk and ileal rectal anastomosis the highest.

  1. Douglas K. Rex, MD

Using a national registry, researchers in Sweden examined the incidence of rectal cancer after various ulcerative colitis operations, including the ileal pouch anal anastomosis (IPAA), ileal rectal anastomosis (IRA), and diversion with the rectum left intact (DR). Apparently, IRA is used commonly in Sweden, whereas in the U.S. it is used primarily only as an initial-stage operation in patients with acute severe ulcerative colitis who require emergent colectomy.

The number of patients undergoing IPAA was 1796, 1112 underwent IRA, and 4358 had DR, primarily pending a definitive operation. Compared with the Swedish general population, patients with an intact rectum after colectomy or diversion had a standardized incidence ratio (SIR) of rectal cancer of 3.8. Following IRA, the absolute risk for rectal cancer was 1.6% at 10 years and 5.6% at 20 years (SIR, 8.7). Following IPAA, only one patient developed rectal cancer during a mean follow-up of 12.2 years (SIR, 0.4). Colectomy for high-grade dysplasia or colon cancer was associated with an elevated risk for rectal cancer in patients with an intact rectum.


Previous evidence indicates that special attention should be paid to patients who have undergone IPAA when the indication for colectomy was dysplasia or cancer and intact rectal mucosa is present. Not all IPAAs are constructed the same, and new patients should always have an initial evaluation to determine whether a rim of rectal mucosa persists postoperatively.

Note to readers: At the time NEJM Journal Watch reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

Editor Disclosures at Time of Publication

  • Disclosures for Douglas K. Rex, MD at time of publication Consultant / Advisory board Covidien; Olympus Corporation America; Endo-Aid Ltd.; Endochoice; Boston Scientific; Paion AG; Ironwood Pharmaceuticals; Colonary Solutions; Novo Nordisk Inc.; Medscape Gastroenterology Grant / Research support: Braintree Laboratories Editorial boards World Journal of Gastroenterology; The Journal of Clinical Gastroenterology; Techniques in Gastrointestinal Endoscopy; Gastroenterology & Hepatology; Expert Review of Gastroenterology & Hepatology; Medscape Gastroenterology; World Journal of Gastrointestinal Pharmacology and Therapeutics; Annals of Gastroenterology & Hepatology; World Journal of Gastrointestinal Oncology; Comparative Effectiveness Research; Journal of Anesthesia & Clinical Research; Gastroenterology; World Journal of Gastrointestinal Pathophysiology; Gastroenterology Research and Practice; GI & Hepatology News; Gastroenterology Report; Clinical Epidemiology Reviews; JSM Gastroenterology and Hepatology (associate editor); GI Journal Watch; Austin Journal of Gastroenterology; World Journal of Gastrointestinal Pharmacology & Therapeutics Leadership positions in professional societies American Society for Gastrointestinal Endoscopy (Councilor); US Multi-Society Task Forces (AGA, ACG, ASGE) (Chair)


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