Daijiro Higashi1, Hidetoshi Katsuno2, Hideaki Kimura3, Kenichi Takahashi4, Hiroki Ikeuchi5, Toru Kono6, Riichiro Nezu7, Katsuyoshi Hatakeyama8, Hitoshi Kameyama8, Iwao Sasaki9, Kouhei Fukushima9, Kazuhiro Watanabe9, Masato Kusunoki10, Toshimitsu Araki10, Kiyoshi Maeda11, Shingo Kameoka12, Michio Itabashi12, Sayumi Nakao12, Koutaro Maeda2, Hiroki Ohge13, Yusuke Watadani13, Toshiaki Watanabe14, Eiji Sunami14, Masayuki Hotokezaka15, Akira Sugita16, Yuji Funayama17, Kitaro Futami18. 1. Department of Surgery, Fukuoka University Chikushi Hospital, Chikusino, Japan daijiro@fukuoka-u.ac.jp. 2. Department of Surgery, Fujita Health University, Toyoake, Japan. 3. Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan. 4. Coloproctology Center, Tohoku Rosai Hospital, Sendai, Japan. 5. Department of Inflammatory Bowel Disease Surgery, Hyogo College of Medicine, Nishonomiya, Japan. 6. Advanced Surgery Center Sapporo Higashi Tokushukai Hospital, Sapporo, Japan. 7. Department of Surgery, Nishinomiya Municipal Central Hospital, Nishinomiya, Japan. 8. Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan. 9. Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan. 10. Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan. 11. Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka, Japan. 12. Department of Surgery 2, Tokyo Women's Medical University, Tokyo, Japan. 13. Department of Surgery, Hiroshima University, Hiroshima, Japan. 14. Department of Surgical Oncology and Vascular Surgery, The University of Tokyo, Tokyo, Japan. 15. Department of Surgery, Junwakai Memorial Hospital, Miyazaki, Japan. 16. Inflammatory Bowel Disease Center, Yokohama Municipal Citizen's Hospital, Yokohama, Japan. 17. Coloproctology Center, Tohoku Rosai Hospital, Sendai, Japan Department of Surgery, Sendai Red Cross Hospital, Sendai, Japan. 18. Department of Surgery, Fukuoka University Chikushi Hospital, Chikusino, Japan.
Abstract
BACKGROUND/AIM: Cancer of the intestinal tract (small and large intestine) associated with Crohn's disease has a low incidence but can be fatal if it develops. Thus, the key question is how to deal with this type of cancer. The current study surveyed major medical facilities that treat inflammatory bowel disease (IBD) surgically in Japan in order to examine the clinical features of cancer of the intestinal tract associated with Crohn's disease and explore ways to deal with this cancer in the future. PATIENTS AND METHODS: Sixteen major medical facilities that treat IBD surgically were surveyed regarding cancer of the intestinal tract associated with Crohn's disease. The medical facilities had treated 3,454 patients with Crohn's disease, 122 of whom had developed intestinal cancer. The medical facilities were surveyed regarding those 122 patients. RESULTS: The incidence of intestinal cancer associated with Crohn's disease has increased yearly. Cancer most often developed in the left side of the colon and, particularly, in the rectum and anal canal. Seventy-six percent of cases were diagnosed preoperatively, 4% were diagnosed intraoperatively, while the remaining 20% were diagnosed pathologically after surgery. The most prevalent histological type of cancer was mucinous carcinoma (50%). Forty-two percent of cancers were differentiated, with 4% being poorly differentiated. The surgical procedure performed most often (67%) was abdominoperineal resection. The 5-year survival rate by stage was 88% for Stage I, 68% for Stage II, 71% for Stage IIIa, 25% for Stage IIIb and 0% for Stage IV. Overall, the 5-year survival rate was 52%. CONCLUSION: Gastrointestinal (GI) cancer associated with Crohn's disease had an incidence of 3.5%, but also involved a poor prognosis with a 5-year survival rate of 52%. Early detection through surveillance is crucial to improving the prognosis for patients. However, surveillance of the intestinal tract with endoscopy or contrast studies is technically and diagnostically hampered by Crohn's disease and intestinal strictures. A biopsy of the anal canal, a common site of cancer, can readily be performed and constitutes the first step in surveillance. Copyright
BACKGROUND/AIM: Cancer of the intestinal tract (small and large intestine) associated with Crohn's disease has a low incidence but can be fatal if it develops. Thus, the key question is how to deal with this type of cancer. The current study surveyed major medical facilities that treat inflammatory bowel disease (IBD) surgically in Japan in order to examine the clinical features of cancer of the intestinal tract associated with Crohn's disease and explore ways to deal with this cancer in the future. PATIENTS AND METHODS: Sixteen major medical facilities that treat IBD surgically were surveyed regarding cancer of the intestinal tract associated with Crohn's disease. The medical facilities had treated 3,454 patients with Crohn's disease, 122 of whom had developed intestinal cancer. The medical facilities were surveyed regarding those 122 patients. RESULTS: The incidence of intestinal cancer associated with Crohn's disease has increased yearly. Cancer most often developed in the left side of the colon and, particularly, in the rectum and anal canal. Seventy-six percent of cases were diagnosed preoperatively, 4% were diagnosed intraoperatively, while the remaining 20% were diagnosed pathologically after surgery. The most prevalent histological type of cancer was mucinous carcinoma (50%). Forty-two percent of cancers were differentiated, with 4% being poorly differentiated. The surgical procedure performed most often (67%) was abdominoperineal resection. The 5-year survival rate by stage was 88% for Stage I, 68% for Stage II, 71% for Stage IIIa, 25% for Stage IIIb and 0% for Stage IV. Overall, the 5-year survival rate was 52%. CONCLUSION: Gastrointestinal (GI) cancer associated with Crohn's disease had an incidence of 3.5%, but also involved a poor prognosis with a 5-year survival rate of 52%. Early detection through surveillance is crucial to improving the prognosis for patients. However, surveillance of the intestinal tract with endoscopy or contrast studies is technically and diagnostically hampered by Crohn's disease and intestinal strictures. A biopsy of the anal canal, a common site of cancer, can readily be performed and constitutes the first step in surveillance. Copyright