Malignant and Nonmalignant Complications of the Rectal Stump in Patients with Inflammatory Bowel Disease
Abstract Background Patients with refractory inflammatory bowel disease (IBD) might require a subtotal colectomy with construction of an ileostomy. Due to the risk of nerve damage and pelvic sepsis, the diverted rectum is often left in situ. Evidence on long-term complications of this rectal stump i...
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| Veröffentlicht in: | Inflammatory bowel diseases 2019-01, Vol.25 (2), p.377-384 |
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| creator | Ten Hove, Joren R Bogaerts, Jonathan M K Bak, Michiel T J Laclé, Miangela M Meij, Vincent Derikx, Lauranne A A P Hoentjen, Frank Mahmmod, Nofel van Tuyl, Sebastiaan A Oldenburg, Bas |
| description | Abstract
Background
Patients with refractory inflammatory bowel disease (IBD) might require a subtotal colectomy with construction of an ileostomy. Due to the risk of nerve damage and pelvic sepsis, the diverted rectum is often left in situ. Evidence on long-term complications of this rectal stump is limited, particularly in patients with Crohn's disease (CD). In addition to the risk of development of neoplasia, diversion proctitis is a frequently reported rectal stump associated complication. Surprisingly, clear recommendations concerning rectal stump surveillance and timing of proctectomy are lacking.
Methods
Through the use of a pathology database and a review of medical records, we established a cohort of IBD patients with a diverted rectum. Among these patients, long-term complications of the rectal stump were identified. Main endpoint was advanced neoplasia (carcinoma or high-grade dysplasia [HGD]) in the rectal stump. Risk factors for advanced neoplasia were identified using Cox regression modeling. In the second, prospective part of the study, a questionnaire was sent out to 165 patients with either a rectal stump in situ or who had undergone a proctectomy, in order to identify differences in patient-reported outcome measures associated with the excision of the rectal stump.
Results
From 530 patients with IBD and a (temporal) diversion of the rectum, we included 250 patients in whom the rectal stump was left in situ for more than 12 months. The majority of patients was female (61%) and had Crohn's disease (67%). On follow-up (median 8 years), 8 carcinomas, 2 cases of high-grade dysplasia, and 7 cases of low-grade dysplasia were found with incidence rates of 3.9 and 8.5 per 1000 patient-years of follow-up for cancer and all neoplasia, respectively. The 8 cases of rectal stump cancer (RSC) were diagnosed after a median of 15 years after colectomy. A history of colorectal neoplasia was associated with advanced rectal stump neoplasia. Out of 191 patients with endoscopic follow-up, rectal stump inflammation occurred in 161 (88.5%) patients. Results of the questionnaire did not show a significant difference in quality of life between patients with and patients without a rectal stump, although the latter group reported significantly more sexual and urinary symptoms than patients with a rectal stump in situ. The majority of rectal stump patients reported rectal blood loss, but 65.5% of them were not or barely limited in daily life by their rectal stumprela |
| doi_str_mv | 10.1093/ibd/izy253 |
| format | Article |
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Background
Patients with refractory inflammatory bowel disease (IBD) might require a subtotal colectomy with construction of an ileostomy. Due to the risk of nerve damage and pelvic sepsis, the diverted rectum is often left in situ. Evidence on long-term complications of this rectal stump is limited, particularly in patients with Crohn's disease (CD). In addition to the risk of development of neoplasia, diversion proctitis is a frequently reported rectal stump associated complication. Surprisingly, clear recommendations concerning rectal stump surveillance and timing of proctectomy are lacking.
Methods
Through the use of a pathology database and a review of medical records, we established a cohort of IBD patients with a diverted rectum. Among these patients, long-term complications of the rectal stump were identified. Main endpoint was advanced neoplasia (carcinoma or high-grade dysplasia [HGD]) in the rectal stump. Risk factors for advanced neoplasia were identified using Cox regression modeling. In the second, prospective part of the study, a questionnaire was sent out to 165 patients with either a rectal stump in situ or who had undergone a proctectomy, in order to identify differences in patient-reported outcome measures associated with the excision of the rectal stump.
Results
From 530 patients with IBD and a (temporal) diversion of the rectum, we included 250 patients in whom the rectal stump was left in situ for more than 12 months. The majority of patients was female (61%) and had Crohn's disease (67%). On follow-up (median 8 years), 8 carcinomas, 2 cases of high-grade dysplasia, and 7 cases of low-grade dysplasia were found with incidence rates of 3.9 and 8.5 per 1000 patient-years of follow-up for cancer and all neoplasia, respectively. The 8 cases of rectal stump cancer (RSC) were diagnosed after a median of 15 years after colectomy. A history of colorectal neoplasia was associated with advanced rectal stump neoplasia. Out of 191 patients with endoscopic follow-up, rectal stump inflammation occurred in 161 (88.5%) patients. Results of the questionnaire did not show a significant difference in quality of life between patients with and patients without a rectal stump, although the latter group reported significantly more sexual and urinary symptoms than patients with a rectal stump in situ. The majority of rectal stump patients reported rectal blood loss, but 65.5% of them were not or barely limited in daily life by their rectal stumprelated problems.
Conclusion
Rectal stump cancer has a low incidence rate, with patients with a history of colonic neoplasia carrying the highest risk of developing this severe complication. We observed no significant differences in quality of life between rectal stump and postproctectomy patients, but proctectomy surgery is associated with sexual and urinary complications.</description><identifier>ISSN: 1078-0998</identifier><identifier>EISSN: 1536-4844</identifier><identifier>DOI: 10.1093/ibd/izy253</identifier><identifier>PMID: 30085111</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><subject>Adult ; Analysis ; Carcinoma ; Care and treatment ; Colectomy ; Colectomy - adverse effects ; Complications and side effects ; Diseases ; Dysplasia ; Female ; Follow-Up Studies ; Gastrointestinal diseases ; Humans ; Incidence ; Infection ; Inflammatory Bowel Diseases - complications ; Inflammatory Bowel Diseases - surgery ; Intelligence gathering ; Male ; Medical records ; Netherlands - epidemiology ; Postoperative Complications ; Proctitis ; Proctitis - epidemiology ; Proctitis - etiology ; Proctitis - pathology ; Prognosis ; Prospective Studies ; Quality of Life ; Rectal Neoplasms - epidemiology ; Rectal Neoplasms - etiology ; Rectal Neoplasms - pathology ; Retrospective Studies ; Risk factors ; Surgery ; Survival Rate</subject><ispartof>Inflammatory bowel diseases, 2019-01, Vol.25 (2), p.377-384</ispartof><rights>2018 Crohn's & Colitis Foundation. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. 2018</rights><rights>COPYRIGHT 2019 Oxford University Press</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c384t-d997f2445e4ee9ef67615953cb0cb52d2c4144a45a6487d66f9bb14e0afcc50d3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,1578,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30085111$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ten Hove, Joren R</creatorcontrib><creatorcontrib>Bogaerts, Jonathan M K</creatorcontrib><creatorcontrib>Bak, Michiel T J</creatorcontrib><creatorcontrib>Laclé, Miangela M</creatorcontrib><creatorcontrib>Meij, Vincent</creatorcontrib><creatorcontrib>Derikx, Lauranne A A P</creatorcontrib><creatorcontrib>Hoentjen, Frank</creatorcontrib><creatorcontrib>Mahmmod, Nofel</creatorcontrib><creatorcontrib>van Tuyl, Sebastiaan A</creatorcontrib><creatorcontrib>Oldenburg, Bas</creatorcontrib><title>Malignant and Nonmalignant Complications of the Rectal Stump in Patients with Inflammatory Bowel Disease</title><title>Inflammatory bowel diseases</title><addtitle>Inflamm Bowel Dis</addtitle><description>Abstract
Background
Patients with refractory inflammatory bowel disease (IBD) might require a subtotal colectomy with construction of an ileostomy. Due to the risk of nerve damage and pelvic sepsis, the diverted rectum is often left in situ. Evidence on long-term complications of this rectal stump is limited, particularly in patients with Crohn's disease (CD). In addition to the risk of development of neoplasia, diversion proctitis is a frequently reported rectal stump associated complication. Surprisingly, clear recommendations concerning rectal stump surveillance and timing of proctectomy are lacking.
Methods
Through the use of a pathology database and a review of medical records, we established a cohort of IBD patients with a diverted rectum. Among these patients, long-term complications of the rectal stump were identified. Main endpoint was advanced neoplasia (carcinoma or high-grade dysplasia [HGD]) in the rectal stump. Risk factors for advanced neoplasia were identified using Cox regression modeling. In the second, prospective part of the study, a questionnaire was sent out to 165 patients with either a rectal stump in situ or who had undergone a proctectomy, in order to identify differences in patient-reported outcome measures associated with the excision of the rectal stump.
Results
From 530 patients with IBD and a (temporal) diversion of the rectum, we included 250 patients in whom the rectal stump was left in situ for more than 12 months. The majority of patients was female (61%) and had Crohn's disease (67%). On follow-up (median 8 years), 8 carcinomas, 2 cases of high-grade dysplasia, and 7 cases of low-grade dysplasia were found with incidence rates of 3.9 and 8.5 per 1000 patient-years of follow-up for cancer and all neoplasia, respectively. The 8 cases of rectal stump cancer (RSC) were diagnosed after a median of 15 years after colectomy. A history of colorectal neoplasia was associated with advanced rectal stump neoplasia. Out of 191 patients with endoscopic follow-up, rectal stump inflammation occurred in 161 (88.5%) patients. Results of the questionnaire did not show a significant difference in quality of life between patients with and patients without a rectal stump, although the latter group reported significantly more sexual and urinary symptoms than patients with a rectal stump in situ. The majority of rectal stump patients reported rectal blood loss, but 65.5% of them were not or barely limited in daily life by their rectal stumprelated problems.
Conclusion
Rectal stump cancer has a low incidence rate, with patients with a history of colonic neoplasia carrying the highest risk of developing this severe complication. We observed no significant differences in quality of life between rectal stump and postproctectomy patients, but proctectomy surgery is associated with sexual and urinary complications.</description><subject>Adult</subject><subject>Analysis</subject><subject>Carcinoma</subject><subject>Care and treatment</subject><subject>Colectomy</subject><subject>Colectomy - adverse effects</subject><subject>Complications and side effects</subject><subject>Diseases</subject><subject>Dysplasia</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Gastrointestinal diseases</subject><subject>Humans</subject><subject>Incidence</subject><subject>Infection</subject><subject>Inflammatory Bowel Diseases - complications</subject><subject>Inflammatory Bowel Diseases - surgery</subject><subject>Intelligence gathering</subject><subject>Male</subject><subject>Medical records</subject><subject>Netherlands - epidemiology</subject><subject>Postoperative Complications</subject><subject>Proctitis</subject><subject>Proctitis - epidemiology</subject><subject>Proctitis - etiology</subject><subject>Proctitis - pathology</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Quality of Life</subject><subject>Rectal Neoplasms - epidemiology</subject><subject>Rectal Neoplasms - etiology</subject><subject>Rectal Neoplasms - pathology</subject><subject>Retrospective Studies</subject><subject>Risk factors</subject><subject>Surgery</subject><subject>Survival Rate</subject><issn>1078-0998</issn><issn>1536-4844</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp90V1r3iAUB_AwNtaX7WYfYAhjMAZpNWqil92zrit0L-zlWow59nEYTaOhPP30s6QtFMY4F8rxdw7Cv6peEXxEsKTHrh-O3c2u4fRJtU84bWsmGHta7rgTNZZS7FUHKf3BuCkln1d7FGPBCSH71faL9u4y6JCRDgP6GsP40NjEcfLO6OxiSChalLeAfoDJ2qOfeRkn5AL6Xp4h5ISuXd6i82C9Hked47xDH-I1ePTRJdAJXlTPrPYJXt6dh9XvT6e_Np_ri29n55uTi9pQwXI9SNnZhjEODECCbbuWcMmp6bHpeTM0hhHGNOO6ZaIb2tbKvicMsLbGcDzQw-rdunea49UCKavRJQPe6wBxSarBgskGd5QU-mall9qDcsHGPGtzy9VJSwSmWHRdUUf_UKUGGJ2JAawr_UcD79cBM8eUZrBqmt2o550iWN0Gpkpgag2s4Nd33136EYYHep9QAW9XEJfpf4v-As5Nnfk</recordid><startdate>20190110</startdate><enddate>20190110</enddate><creator>Ten Hove, Joren R</creator><creator>Bogaerts, Jonathan M K</creator><creator>Bak, Michiel T J</creator><creator>Laclé, Miangela M</creator><creator>Meij, Vincent</creator><creator>Derikx, Lauranne A A P</creator><creator>Hoentjen, Frank</creator><creator>Mahmmod, Nofel</creator><creator>van Tuyl, Sebastiaan A</creator><creator>Oldenburg, Bas</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20190110</creationdate><title>Malignant and Nonmalignant Complications of the Rectal Stump in Patients with Inflammatory Bowel Disease</title><author>Ten Hove, Joren R ; Bogaerts, Jonathan M K ; Bak, Michiel T J ; Laclé, Miangela M ; Meij, Vincent ; Derikx, Lauranne A A P ; Hoentjen, Frank ; Mahmmod, Nofel ; van Tuyl, Sebastiaan A ; Oldenburg, Bas</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c384t-d997f2445e4ee9ef67615953cb0cb52d2c4144a45a6487d66f9bb14e0afcc50d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adult</topic><topic>Analysis</topic><topic>Carcinoma</topic><topic>Care and treatment</topic><topic>Colectomy</topic><topic>Colectomy - adverse effects</topic><topic>Complications and side effects</topic><topic>Diseases</topic><topic>Dysplasia</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Gastrointestinal diseases</topic><topic>Humans</topic><topic>Incidence</topic><topic>Infection</topic><topic>Inflammatory Bowel Diseases - complications</topic><topic>Inflammatory Bowel Diseases - surgery</topic><topic>Intelligence gathering</topic><topic>Male</topic><topic>Medical records</topic><topic>Netherlands - epidemiology</topic><topic>Postoperative Complications</topic><topic>Proctitis</topic><topic>Proctitis - epidemiology</topic><topic>Proctitis - etiology</topic><topic>Proctitis - pathology</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Quality of Life</topic><topic>Rectal Neoplasms - epidemiology</topic><topic>Rectal Neoplasms - etiology</topic><topic>Rectal Neoplasms - pathology</topic><topic>Retrospective Studies</topic><topic>Risk factors</topic><topic>Surgery</topic><topic>Survival Rate</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ten Hove, Joren R</creatorcontrib><creatorcontrib>Bogaerts, Jonathan M K</creatorcontrib><creatorcontrib>Bak, Michiel T J</creatorcontrib><creatorcontrib>Laclé, Miangela M</creatorcontrib><creatorcontrib>Meij, Vincent</creatorcontrib><creatorcontrib>Derikx, Lauranne A A P</creatorcontrib><creatorcontrib>Hoentjen, Frank</creatorcontrib><creatorcontrib>Mahmmod, Nofel</creatorcontrib><creatorcontrib>van Tuyl, Sebastiaan A</creatorcontrib><creatorcontrib>Oldenburg, Bas</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Inflammatory bowel diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ten Hove, Joren R</au><au>Bogaerts, Jonathan M K</au><au>Bak, Michiel T J</au><au>Laclé, Miangela M</au><au>Meij, Vincent</au><au>Derikx, Lauranne A A P</au><au>Hoentjen, Frank</au><au>Mahmmod, Nofel</au><au>van Tuyl, Sebastiaan A</au><au>Oldenburg, Bas</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Malignant and Nonmalignant Complications of the Rectal Stump in Patients with Inflammatory Bowel Disease</atitle><jtitle>Inflammatory bowel diseases</jtitle><addtitle>Inflamm Bowel Dis</addtitle><date>2019-01-10</date><risdate>2019</risdate><volume>25</volume><issue>2</issue><spage>377</spage><epage>384</epage><pages>377-384</pages><issn>1078-0998</issn><eissn>1536-4844</eissn><abstract>Abstract
Background
Patients with refractory inflammatory bowel disease (IBD) might require a subtotal colectomy with construction of an ileostomy. Due to the risk of nerve damage and pelvic sepsis, the diverted rectum is often left in situ. Evidence on long-term complications of this rectal stump is limited, particularly in patients with Crohn's disease (CD). In addition to the risk of development of neoplasia, diversion proctitis is a frequently reported rectal stump associated complication. Surprisingly, clear recommendations concerning rectal stump surveillance and timing of proctectomy are lacking.
Methods
Through the use of a pathology database and a review of medical records, we established a cohort of IBD patients with a diverted rectum. Among these patients, long-term complications of the rectal stump were identified. Main endpoint was advanced neoplasia (carcinoma or high-grade dysplasia [HGD]) in the rectal stump. Risk factors for advanced neoplasia were identified using Cox regression modeling. In the second, prospective part of the study, a questionnaire was sent out to 165 patients with either a rectal stump in situ or who had undergone a proctectomy, in order to identify differences in patient-reported outcome measures associated with the excision of the rectal stump.
Results
From 530 patients with IBD and a (temporal) diversion of the rectum, we included 250 patients in whom the rectal stump was left in situ for more than 12 months. The majority of patients was female (61%) and had Crohn's disease (67%). On follow-up (median 8 years), 8 carcinomas, 2 cases of high-grade dysplasia, and 7 cases of low-grade dysplasia were found with incidence rates of 3.9 and 8.5 per 1000 patient-years of follow-up for cancer and all neoplasia, respectively. The 8 cases of rectal stump cancer (RSC) were diagnosed after a median of 15 years after colectomy. A history of colorectal neoplasia was associated with advanced rectal stump neoplasia. Out of 191 patients with endoscopic follow-up, rectal stump inflammation occurred in 161 (88.5%) patients. Results of the questionnaire did not show a significant difference in quality of life between patients with and patients without a rectal stump, although the latter group reported significantly more sexual and urinary symptoms than patients with a rectal stump in situ. The majority of rectal stump patients reported rectal blood loss, but 65.5% of them were not or barely limited in daily life by their rectal stumprelated problems.
Conclusion
Rectal stump cancer has a low incidence rate, with patients with a history of colonic neoplasia carrying the highest risk of developing this severe complication. We observed no significant differences in quality of life between rectal stump and postproctectomy patients, but proctectomy surgery is associated with sexual and urinary complications.</abstract><cop>US</cop><pub>Oxford University Press</pub><pmid>30085111</pmid><doi>10.1093/ibd/izy253</doi><tpages>8</tpages></addata></record> |
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| ispartof | Inflammatory bowel diseases, 2019-01, Vol.25 (2), p.377-384 |
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| source | MEDLINE; Oxford University Press Journals All Titles (1996-Current) |
| subjects | Adult Analysis Carcinoma Care and treatment Colectomy Colectomy - adverse effects Complications and side effects Diseases Dysplasia Female Follow-Up Studies Gastrointestinal diseases Humans Incidence Infection Inflammatory Bowel Diseases - complications Inflammatory Bowel Diseases - surgery Intelligence gathering Male Medical records Netherlands - epidemiology Postoperative Complications Proctitis Proctitis - epidemiology Proctitis - etiology Proctitis - pathology Prognosis Prospective Studies Quality of Life Rectal Neoplasms - epidemiology Rectal Neoplasms - etiology Rectal Neoplasms - pathology Retrospective Studies Risk factors Surgery Survival Rate |
| title | Malignant and Nonmalignant Complications of the Rectal Stump in Patients with Inflammatory Bowel Disease |
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