Ileoanal Pouch And Its Association With Incidental Colorectal Dysplasia

Results of a new study revealed that regardless of the time of diagnosis of inflammatory bowel disease-associated dysplasia, an ileoanal pouch may be associated with good long-term outcomes.

“The incidental finding of dysplasia during proctocolectomy does not seem to be associated with worsened outcomes compared to preoperatively diagnosed dysplasia,” said Marianna Maspero, MD, of the colon and rectal surgery department at the Cleveland Clinic in Cleveland, Ohio. Maspero et al hypothesized incidental colorectal dysplasia is associated with worse oncologic outcomes compared to dysplasia diagnosed preoperatively for the study.

“In cases of invisible or non-endoscopically resectable dysplasia found at colonoscopy, total proctocolectomy with ileal pouch anal anastomosis can be offered with good long-term oncological outcomes and pouch survival,” they explained. “However, little is known regarding cancer-related outcomes when dysplasia is found incidentally after surgery.”

For the research, the authors used data from 517 patients who had a preoperative dysplasia or dysplasia found only after colectomy. These patients were further divided into 3 categories: ONLYPRE (+preoperative biopsy, negative final pathology), PREFINAL (+preoperative biopsy and final pathology), and ONLYFINAL (negative preoperative biopsy, +final pathology) The PREFINAL category made up for the majority of the study population with 254 (49%) patients, ONLYFINAL had 137 (26%) patients, and ONLYPRE had 125 (24%) patients. The median age was 46 and 64% of the study population were men. The preoperative diagnosis for more than 90% of the cases was ulcerative colitis.

The results found that after a median follow-up of 12 years, there were no differences in overall, disease-free or pouch survival between groups. Cancer/dysplasia developed in 11 patients: 3 (2%) in the ONLYPRE, 5 (2%) in the PREPOST, and 3 (2%) in the ONLYPOST group. In the entire cohort, there was 1 cancer-related death reported (in the ONLYPRE group)

Disease-free survival at 10 years was 98% for ONLYPRE, 98% for PREPOST, and 98% for ONLYPOST.

Pouch survival at 10 years was 96% for ONLYPRE, 99% for PREPOST, and 97% for ONLYPOST.

Maspero et al presented an abstract at the Crohn’s and Colitis Congress 2023 in Denver, Colorado.

—Priyam Vora

Reference:
Maspero M, Otero A, Lipman J et al. Presentation number: P057. Incidental dysplasia during total proctocolectomy with ileoanal pouch: Is it associated with worse outcomes? Presented at: Crohn’s and Colitis Congress 2023; January 19, 2023. Denver, Colorado.