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Proctocolectomy for colorectal cancer—is the ileal pouch anal anastomosis a safe alternative to permanent ileostomy?

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Abstract

Purpose

Ileal pouch anal anastomosis (IPAA) is the procedure of choice in patients requiring surgery for ulcerative colitis (UC) and familial adenomatous polyposis (FAP). There are few data on reconstruction with the IPAA in patients with colorectal cancer (CRC). This study assessed the outcomes of the IPAA compared to proctocolectomy and permanent ileostomy (PI) on these patients.

Methods

Between 1983 and 2013, over 2800 patients with CRC have been treated at the Mount Sinai Hospital (MSH). Demographic, surgical, pathological, and outcome data for all patients have been maintained in a database—73 patients were treated for CRC with proctocolectomy: 39 patients with IPAA and 34 patients with PI. Clinical features, pathologic findings, and survival outcomes were compared between these groups.

Results

Each group was similar with respect to gender, stage, and histologic grade. Patients undergoing IPAA were significantly younger. The diagnosis leading to proctocolectomy was more commonly UC or FAP in patients treated with IPAA (39/39 vs. 23/34, p = 0.001). Rectal cancer subgroups were similar in age, sex, TNM stage, T-stage, height of tumor, and histologic grade. There was no significant difference in overall or disease free survival between groups for colon or rectal primaries. Analysis using the Cochran-Armitage trend test suggests that utilization of IPAA has increased over time (p = 0.002).

Conclusions

The IPAA is a viable and safe option to select for patients who would otherwise require PI. Increased experience and improved outcomes following IPAA has led to its more liberal use in selected patients.

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Conflicts of interest

There are no conflicts of interest.

Financial support

The authors received no financial support for this research.

Author information

Authors and Affiliations

  1. Department of Surgery, University of Toronto, Toronto, ON, Canada

    Ryan Snelgrove, Robert Gryfe, Helen MacRae, Zane Cohen & Robin S. McLeod

  2. Department of Surgery, University of British Columbia, Vancouver, BC, Canada

    Carl J. Brown

  3. Zane Cohen Clinical Research Centre and Samuel Lunenfeld Research Institute, Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada

    Brenda I. O’Connor, Harden Huang, Helen MacRae, Zane Cohen & Robin S. McLeod

  4. Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, ON, Canada

    J. Charles Victor

  5. Colon and Rectal Surgery and Cancer Molecular Genetics, Mount Sinai and Princess Margaret Hospitals, Toronto, ON, Canada

    Robert Gryfe

  6. Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada

    Robin S. McLeod

  7. Mt. Sinai Hospital, Room 449, 600 University Avenue, Toronto, ON, M5G 1X5, Canada

    Robin S. McLeod

Authors
  1. Ryan Snelgrove
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  2. Carl J. Brown
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  3. Brenda I. O’Connor
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  4. Harden Huang
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  5. J. Charles Victor
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  6. Robert Gryfe
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  7. Helen MacRae
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  8. Zane Cohen
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  9. Robin S. McLeod
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Correspondence to Robin S. McLeod.

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Snelgrove, R., Brown, C.J., O’Connor, B.I. et al. Proctocolectomy for colorectal cancer—is the ileal pouch anal anastomosis a safe alternative to permanent ileostomy?. Int J Colorectal Dis 29, 1485–1491 (2014). https://doi.org/10.1007/s00384-014-2027-3

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  • DOI: https://doi.org/10.1007/s00384-014-2027-3

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