Motoi Uchino1, Hiroki Ikeuchi1, Keisuke Hata2, Tomohiro Minagawa1, Yuki Horio1, Ryuichi Kuwahara1, Shiro Nakamura3, Kenji Watanabe4, Masayuki Saruta5, Toshimitsu Fujii6, Taku Kobayashi7, Ken Sugimoto8, Fumihito Hirai9, Motohiro Esaki10, Sakiko Hiraoka11, Katsuyoshi Matsuoka12, Shinichiro Shinzaki13, Minoru Matsuura14, Nagamu Inoue15, Hiroshi Nakase16, Mamoru Watanabe6. 1. Department of Inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya, Japan. 2. Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan. 3. Department of Internal Medicine II, Osaka Medical College Hospital, Osaka, Japan. 4. Center for Inflammatory Bowel Disease, Division of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan. 5. Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan. 6. Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan. 7. Center for Advanced IBD Research and Treatment, Kitasato University, Kitasato Institute Hospital, Tokyo, Japan. 8. First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan. 9. Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan. 10. Department of Endoscopic Diagnostics and Therapeutics, Saga University Hospital, Saga, Japan. 11. Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. 12. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Sakura Medical Center, Sakura, Japan. 13. Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan. 14. Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan. 15. Center for Preventive Medicine, Keio University Hospital, Tokyo, Japan. 16. Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan.
Abstract
BACKGROUND AND AIM: Although surveillance colonoscopy is recommended by several guidelines for Crohn's disease (CD), the evidence is insufficient to support the validity of this recommendation. Moreover, the efficacy of surveillance colonoscopy for anorectal cancer remains unclear. Therefore, we performed a systematic review of cancer in patients with CD before considering the proper surveillance methods. METHODS: We conducted a systematic review and meta-analysis examining the incidence of intestinal cancer and a literature review to clarify the characteristic features of cancer in CD. We performed the systematic literature review of studies published up to May 2019. RESULTS: Overall, 7344 patients were included in eight studies. The standardized incidence ratios (95% confidence intervals) of colorectal cancer (CRC) and small bowel cancer (SBC) were 2.08 (1.43-3.02) and 22.01 (9.10-53.25), respectively. The prevalence of CRC and SBC was 57/7344 (0.77%) and 17/7344 (0.23%), respectively, during a median follow-up of 12.55 years. Additionally, 54 studies reporting 208 anorectal cancer cases were identified. In patients with anorectal cancer, the prognosis for survival was 2.1 ± 2.3 years, and advanced cancer greater than stage T3 occurred in 46/74 patients (62.1%). Many more reports of anorectal cancer were published in Asia than in Western countries. CONCLUSION: Although we were unable to state a recommendation for surveillance for SBC, we should perform cancer surveillance for CRC in patients with CD. However, the characteristics of cancer may differ according to geography or race. We must establish proper and effective surveillance methods that are independently suitable to detect these differences.
BACKGROUND AND AIM: Although surveillance colonoscopy is recommended by several guidelines for Crohn's disease (CD), the evidence is insufficient to support the validity of this recommendation. Moreover, the efficacy of surveillance colonoscopy for anorectal cancer remains unclear. Therefore, we performed a systematic review of cancer in patients with CD before considering the proper surveillance methods. METHODS: We conducted a systematic review and meta-analysis examining the incidence of intestinal cancer and a literature review to clarify the characteristic features of cancer in CD. We performed the systematic literature review of studies published up to May 2019. RESULTS: Overall, 7344 patients were included in eight studies. The standardized incidence ratios (95% confidence intervals) of colorectal cancer (CRC) and small bowel cancer (SBC) were 2.08 (1.43-3.02) and 22.01 (9.10-53.25), respectively. The prevalence of CRC and SBC was 57/7344 (0.77%) and 17/7344 (0.23%), respectively, during a median follow-up of 12.55 years. Additionally, 54 studies reporting 208 anorectal cancer cases were identified. In patients with anorectal cancer, the prognosis for survival was 2.1 ± 2.3 years, and advanced cancer greater than stage T3 occurred in 46/74 patients (62.1%). Many more reports of anorectal cancer were published in Asia than in Western countries. CONCLUSION: Although we were unable to state a recommendation for surveillance for SBC, we should perform cancer surveillance for CRC in patients with CD. However, the characteristics of cancer may differ according to geography or race. We must establish proper and effective surveillance methods that are independently suitable to detect these differences.