Long-term Risk of Cancer Following Ileal Pouch-anal Anastomosis for Ulcerative Colitis

Anders Mark-Christensen, Rune Erichsen, Søren Brandsborg, Jacob Rosenberg, Niels Qvist, Ole Thorlacius-Ussing, Jens Hillingsø, Jørn Helmut Pachler, Erica Gould Christiansen, Søren Laurberg

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

    Resumé

    Background: The overall risk of cancer following ileal pouch-anal anastomosis [IPAA] is unknown, and pouch cancer surveillance is controversial. We evaluated long-term risk of cancer in a national cohort of patients with ulcerative colitis and IPAA, with emphasis on pouch cancer.

    Methods: Data on incident cancers were extracted from the national Danish Cancer Registry. Incidence rates for all site-specific cancers were compared between patients with IPAA and a gender- and age-matched comparison cohort from the background population to obtain incidence rate ratios [IRRs].

    Results: A total of 1723 patients with IPAA, operated for ulcerative colitis in the period 1980-2010, were matched to 8615 individuals from the background population. During a median follow-up of 12.9 years (interquartile range [IQR] 7.7-19.6 years), two pouch cancers [0.12%] were found after 16 and 27 years, respectively. In the population comparison cohort, 38 intestinal cancers [0.45%] were found, of which 35 were colorectal. The risk of hepatobiliary cancer was higher for patients with IPAA {IRR = 13.0 (95% confidence interval [CI]: 3.1-76.1)}, and half of the affected patients had coexisting primary sclerosing cholangitis. The risk of cancer overall following IPAA was identical to that of the comparison cohort: IRR = 1.05 [0.84-1.31].

    Conclusions: Pouch cancer following IPAA is very rare, questioning the need for general, rather than selective, surveillance. The overall cancer risk is comparable to that of the background population, and the increased risk of hepatobiliary cancer is likely an effect of coexisting liver disease and not causally related to IPAA.

    OriginalsprogEngelsk
    TidsskriftJournal of Crohn's and Colitis
    Vol/bind12
    Udgave nummer1
    Sider (fra-til)57–62
    ISSN1873-9946
    DOI
    StatusUdgivet - 5. jan. 2018

    Fingeraftryk

    Colonic Pouches
    Ulcerative Colitis
    Neoplasms
    Incidence
    Population
    Intestinal Neoplasms
    Sclerosing Cholangitis
    Registries
    Liver Diseases

    Citer dette

    Mark-Christensen, A., Erichsen, R., Brandsborg, S., Rosenberg, J., Qvist, N., Thorlacius-Ussing, O., ... Laurberg, S. (2018). Long-term Risk of Cancer Following Ileal Pouch-anal Anastomosis for Ulcerative Colitis. Journal of Crohn's and Colitis, 12(1), 57–62. https://doi.org/10.1093/ecco-jcc/jjx112
    Mark-Christensen, Anders ; Erichsen, Rune ; Brandsborg, Søren ; Rosenberg, Jacob ; Qvist, Niels ; Thorlacius-Ussing, Ole ; Hillingsø, Jens ; Pachler, Jørn Helmut ; Christiansen, Erica Gould ; Laurberg, Søren. / Long-term Risk of Cancer Following Ileal Pouch-anal Anastomosis for Ulcerative Colitis. I: Journal of Crohn's and Colitis. 2018 ; Bind 12, Nr. 1. s. 57–62.
    @article{0be298f4710d448c83885bbaeaaa927a,
    title = "Long-term Risk of Cancer Following Ileal Pouch-anal Anastomosis for Ulcerative Colitis",
    abstract = "Background: The overall risk of cancer following ileal pouch-anal anastomosis [IPAA] is unknown, and pouch cancer surveillance is controversial. We evaluated long-term risk of cancer in a national cohort of patients with ulcerative colitis and IPAA, with emphasis on pouch cancer.Methods: Data on incident cancers were extracted from the national Danish Cancer Registry. Incidence rates for all site-specific cancers were compared between patients with IPAA and a gender- and age-matched comparison cohort from the background population to obtain incidence rate ratios [IRRs].Results: A total of 1723 patients with IPAA, operated for ulcerative colitis in the period 1980-2010, were matched to 8615 individuals from the background population. During a median follow-up of 12.9 years (interquartile range [IQR] 7.7-19.6 years), two pouch cancers [0.12{\%}] were found after 16 and 27 years, respectively. In the population comparison cohort, 38 intestinal cancers [0.45{\%}] were found, of which 35 were colorectal. The risk of hepatobiliary cancer was higher for patients with IPAA {IRR = 13.0 (95{\%} confidence interval [CI]: 3.1-76.1)}, and half of the affected patients had coexisting primary sclerosing cholangitis. The risk of cancer overall following IPAA was identical to that of the comparison cohort: IRR = 1.05 [0.84-1.31].Conclusions: Pouch cancer following IPAA is very rare, questioning the need for general, rather than selective, surveillance. The overall cancer risk is comparable to that of the background population, and the increased risk of hepatobiliary cancer is likely an effect of coexisting liver disease and not causally related to IPAA.",
    keywords = "Journal Article, Cancer, Ileal pouch-anal anastomosis, Ulcerative colitis, Colorectal Neoplasms/epidemiology, Follow-Up Studies, Biliary Tract Neoplasms/epidemiology, Humans, Liver Neoplasms/epidemiology, Colonic Pouches/pathology, Male, Case-Control Studies, Incidence, Young Adult, Denmark/epidemiology, Time Factors, Adult, Female, Registries, Cholangitis, Sclerosing/complications, Proctocolectomy, Restorative, Colitis, Ulcerative/complications",
    author = "Anders Mark-Christensen and Rune Erichsen and S{\o}ren Brandsborg and Jacob Rosenberg and Niels Qvist and Ole Thorlacius-Ussing and Jens Hillings{\o} and Pachler, {J{\o}rn Helmut} and Christiansen, {Erica Gould} and S{\o}ren Laurberg",
    year = "2018",
    month = "1",
    day = "5",
    doi = "10.1093/ecco-jcc/jjx112",
    language = "English",
    volume = "12",
    pages = "57–62",
    journal = "Journal of Crohn's and Colitis",
    issn = "1873-9946",
    publisher = "Heinemann",
    number = "1",

    }

    Mark-Christensen, A, Erichsen, R, Brandsborg, S, Rosenberg, J, Qvist, N, Thorlacius-Ussing, O, Hillingsø, J, Pachler, JH, Christiansen, EG & Laurberg, S 2018, 'Long-term Risk of Cancer Following Ileal Pouch-anal Anastomosis for Ulcerative Colitis', Journal of Crohn's and Colitis, bind 12, nr. 1, s. 57–62. https://doi.org/10.1093/ecco-jcc/jjx112

    Long-term Risk of Cancer Following Ileal Pouch-anal Anastomosis for Ulcerative Colitis. / Mark-Christensen, Anders; Erichsen, Rune; Brandsborg, Søren; Rosenberg, Jacob; Qvist, Niels; Thorlacius-Ussing, Ole; Hillingsø, Jens; Pachler, Jørn Helmut; Christiansen, Erica Gould; Laurberg, Søren.

    I: Journal of Crohn's and Colitis, Bind 12, Nr. 1, 05.01.2018, s. 57–62.

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

    TY - JOUR

    T1 - Long-term Risk of Cancer Following Ileal Pouch-anal Anastomosis for Ulcerative Colitis

    AU - Mark-Christensen, Anders

    AU - Erichsen, Rune

    AU - Brandsborg, Søren

    AU - Rosenberg, Jacob

    AU - Qvist, Niels

    AU - Thorlacius-Ussing, Ole

    AU - Hillingsø, Jens

    AU - Pachler, Jørn Helmut

    AU - Christiansen, Erica Gould

    AU - Laurberg, Søren

    PY - 2018/1/5

    Y1 - 2018/1/5

    N2 - Background: The overall risk of cancer following ileal pouch-anal anastomosis [IPAA] is unknown, and pouch cancer surveillance is controversial. We evaluated long-term risk of cancer in a national cohort of patients with ulcerative colitis and IPAA, with emphasis on pouch cancer.Methods: Data on incident cancers were extracted from the national Danish Cancer Registry. Incidence rates for all site-specific cancers were compared between patients with IPAA and a gender- and age-matched comparison cohort from the background population to obtain incidence rate ratios [IRRs].Results: A total of 1723 patients with IPAA, operated for ulcerative colitis in the period 1980-2010, were matched to 8615 individuals from the background population. During a median follow-up of 12.9 years (interquartile range [IQR] 7.7-19.6 years), two pouch cancers [0.12%] were found after 16 and 27 years, respectively. In the population comparison cohort, 38 intestinal cancers [0.45%] were found, of which 35 were colorectal. The risk of hepatobiliary cancer was higher for patients with IPAA {IRR = 13.0 (95% confidence interval [CI]: 3.1-76.1)}, and half of the affected patients had coexisting primary sclerosing cholangitis. The risk of cancer overall following IPAA was identical to that of the comparison cohort: IRR = 1.05 [0.84-1.31].Conclusions: Pouch cancer following IPAA is very rare, questioning the need for general, rather than selective, surveillance. The overall cancer risk is comparable to that of the background population, and the increased risk of hepatobiliary cancer is likely an effect of coexisting liver disease and not causally related to IPAA.

    AB - Background: The overall risk of cancer following ileal pouch-anal anastomosis [IPAA] is unknown, and pouch cancer surveillance is controversial. We evaluated long-term risk of cancer in a national cohort of patients with ulcerative colitis and IPAA, with emphasis on pouch cancer.Methods: Data on incident cancers were extracted from the national Danish Cancer Registry. Incidence rates for all site-specific cancers were compared between patients with IPAA and a gender- and age-matched comparison cohort from the background population to obtain incidence rate ratios [IRRs].Results: A total of 1723 patients with IPAA, operated for ulcerative colitis in the period 1980-2010, were matched to 8615 individuals from the background population. During a median follow-up of 12.9 years (interquartile range [IQR] 7.7-19.6 years), two pouch cancers [0.12%] were found after 16 and 27 years, respectively. In the population comparison cohort, 38 intestinal cancers [0.45%] were found, of which 35 were colorectal. The risk of hepatobiliary cancer was higher for patients with IPAA {IRR = 13.0 (95% confidence interval [CI]: 3.1-76.1)}, and half of the affected patients had coexisting primary sclerosing cholangitis. The risk of cancer overall following IPAA was identical to that of the comparison cohort: IRR = 1.05 [0.84-1.31].Conclusions: Pouch cancer following IPAA is very rare, questioning the need for general, rather than selective, surveillance. The overall cancer risk is comparable to that of the background population, and the increased risk of hepatobiliary cancer is likely an effect of coexisting liver disease and not causally related to IPAA.

    KW - Journal Article

    KW - Cancer

    KW - Ileal pouch-anal anastomosis

    KW - Ulcerative colitis

    KW - Colorectal Neoplasms/epidemiology

    KW - Follow-Up Studies

    KW - Biliary Tract Neoplasms/epidemiology

    KW - Humans

    KW - Liver Neoplasms/epidemiology

    KW - Colonic Pouches/pathology

    KW - Male

    KW - Case-Control Studies

    KW - Incidence

    KW - Young Adult

    KW - Denmark/epidemiology

    KW - Time Factors

    KW - Adult

    KW - Female

    KW - Registries

    KW - Cholangitis, Sclerosing/complications

    KW - Proctocolectomy, Restorative

    KW - Colitis, Ulcerative/complications

    U2 - 10.1093/ecco-jcc/jjx112

    DO - 10.1093/ecco-jcc/jjx112

    M3 - Journal article

    C2 - 28981638

    VL - 12

    SP - 57

    EP - 62

    JO - Journal of Crohn's and Colitis

    JF - Journal of Crohn's and Colitis

    SN - 1873-9946

    IS - 1

    ER -

    Mark-Christensen A, Erichsen R, Brandsborg S, Rosenberg J, Qvist N, Thorlacius-Ussing O et al. Long-term Risk of Cancer Following Ileal Pouch-anal Anastomosis for Ulcerative Colitis. Journal of Crohn's and Colitis. 2018 jan 5;12(1):57–62. https://doi.org/10.1093/ecco-jcc/jjx112