Clinical Features and Oncologic Outcomes in Patients With Rectal Cancer and Ulcerative Colitis: A Single-Institution Experience

BACKGROUND: Patients with chronic ulcerative colitis are at increased risk of developing colorectal cancer. Limited data exists in ulcerative colitis patients with rectal cancer regarding clinical and oncologic outcomes, and the ideal operative approach. OBJECTIVE: To describe our experience in the management of patients with rectal cancer in the setting of chronic ulcerative colitis and their outcomes. DESIGN: This study is a retrospective review of all patients with ulcerative colitis who underwent a colorectal operation between 1990 and 2009. SETTINGS: This study was conducted at a tertiary care center. PATIENTS: Adult patients with rectal adenocarcinoma undergoing a colorectal operation for chronic ulcerative colitis were included in this study. Patients with colonic malignancy, indeterminate colitis, and Crohn's disease were excluded. MAIN OUTCOME MEASURES: Clinical features and long-term oncologic outcomes are described. RESULTS: Forty-one patients were identified; their mean age was 53.9 years. Mean duration of ulcerative colitis was 22.5 years. Thirty-four patients (83%) were known to have cancer preoperatively; in 7 patients it was discovered on postoperative pathology. Eight of the tumors were in the proximal rectum, 19 in the mid rectum, and 13 in the distal rectum. The most common operation performed was total proctocolectomy with end ileostomy (n = 21), followed by IPAA. The majority of patients (n = 28, 68%) had stage I or II disease. Estimates of overall survival at 1 and 5 years were 83% and 62%, and, for disease-free survival, the estimates were 93% and 62%. Local and distant recurrence was seen in 5 and 9 patients. Eighty-nine percent of the observed recurrences were in patients with stage III and IV disease. Pouch failure occurred in 2 patients. LIMITATIONS: This retrospective study was possibly underpowered, given the small sample sizes. CONCLUSION: In our cohort, rectal cancer in the setting of chronic ulcerative colitis was rare, often presented at an early stage, and was not always diagnosed preoperatively. The presence of early-stage rectal cancer should not be considered a contraindication for IPAA.