TBA (22W143)

Retained Rectums In Ulcerative Colitis Patients; A Ten Year Follow Up

Author(s)

A. Gallagher, J. Sheridan, G. Doherty, H. Mulcahy, G. Cullen

Department(s)/Institutions

Department of Gastroenterology, Centre for Colorectal Disease, St Vincent’s University Hospital, Dublin

Introduction

Patients who undergo subtotal colectomy for Ulcerative Colitis (UC) have a persistent risk of colorectal cancer (CRC) in the retained rectum and this increases overtime. There are currently no guidelines for rectal surveillance in this group.

Aims/Background

To assess the outcome of the retained rectum post colectomy in patients with UC.

Method

We conducted a retrospective analysis of patients with UC who underwent colorectal surgery in a tertiary referral centre. The Hospital In-Patient Enquiry system and the SVUH IBD Database were used to identify patients. Patients with colorectal cancer were excluded.

Results

In a six year period one-hundred and seventy six bowel surgeries were carried out for patients with Inflammatory Bowel Disease. Sixty five of these procedures were performed on patients with UC, eight of which would subsequently be re-diagnosed with Crohn’s Disease. 73.6% (n=42) had a completion proctectomy within ten years, 12% (n=7) were lost to follow up and 5% (n=3) died from non-gastrointestinal disorders. 8.7% (n=5) retained their rectum after ten years. For patients who had a completion proctectomy the median time to surgery was two years. All patients in the retained rectum group had surveillance proctoscopy with a median frequency of 2.4 years. The risk of further surgery was a factor for two patients due to obesity and decompensated liver disease. A third patient had an ileorectal anastamosis abroad and continues to have active rectal disease. Dysplasia was found in the rectum of the fourth patient thirteen years post colectomy. A rectal adenocarcinoma was diagnosed ten years post-operation in the fifth patient.

Conclusions

Despite the absence of guidelines for completion proctectomy and/or surveillance of the retained rectal stump, three quarters of our UC patients had undergone completion proctectomy within ten years. A small but significant number of patients have a residual rectal stump after ten years, they require CRC surveillance and clear guidelines on this are needed.