The risk of rectal carcinoma following colectomy in ulcerative colitis

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Abstract
In a series of 1439 patients with ulcerative colitis, surgical resection was performed on 374 patients (26%): colectomy, 273 (subtotal colectomy and mucous fistula, 172, colectomy and primary ileorectal anastomosis, 101); protocolectomy, 61 and miscellaneous procedures, 40. Of the 172 patients undergoing subtotal colectomy and mucous fistula, 93 (54%) subsequently required rectal excision, 33 (19%) had ileorectal anastomosis performed as a 2nd procedure, and, in 46 (27%), the rectum remained as a mucous fistula. A total of 273 patients were at risk for the development of rectal cancer after subtotal colectomy; 10 patients (3.6%) subsequently developed rectal cancer. The cumulative probability of developing rectal cancer after subtotal colectomy reached 17% at 27 yr from disease onset. The tumors were more advanced in stage and of higher grade malignancy than those of parallel general series of patients with rectal cancer uncomplicated by inflammatory bowel disease. Colectomy and ileorectal anastomosis were successful for most patients. However, the experience of this series highlights the danger of carcinomatous transformation in the retained rectum, the requirement for regular long-term follow-up, the need for markers for precancerous change and the value, when relevant, of prophylactic proctectomy.