Abstract
Introduction
Colon cancer in ulcerative colitis patients with liver transplant (UCCOLT) due to
primary sclerosing cholangitis carries significant treatment challenges. Aim of this
literature search is to review management strategies and provide a framework to facilitate
the decisional process in this clinical setting.
Methods
PRISMA-compliant systematic search was followed by critical expert commentary of the
results and development of a surgical management algorithm. Endpoints included surgical
management, operative strategies, functional and survival outcomes. Technical and
strategics aspects with particular regard to the choice of reconstruction were evaluated
to tentatively develop an integrated algorithm.
Results
Ten studies reporting treatment of 20 UCCOLT patients were identified after screening.
Nine patients underwent proctocolectomy and end-ileostomy (PC) and eleven had restorative
ileal pouch-anal anastomosis (IPAA). Reported results for perioperative outcomes,
oncological outcomes, and graft loss were comparable for both procedures. There were
no reports of subtotal colectomies and ileo-rectal anastomosis (IRA).
Conclusions
Literature in the field is scarce and decision-making is particularly complex. PC
and IPAA have been reported with good results. Nevertheless, IRA may also be considered
in UCCOLT patients in selected cases, reducing the risks of sepsis, OLT and pouch
failure; furthermore, in young patients, it has the advantage of preserving fertility
or sexual function. The proposed treatment algorithm may represent a valuable support
in guiding surgical strategy.
Keywords
Abbreviations:
UC (ulcerative colitis), CC (colon cancer), PSC (primary sclerosing cholangitis), OLT (orthotopic liver transplant)To read this article in full you will need to make a payment
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References
- Epidemiology and outcomes of primary sclerosing cholangitis with and without inflammatory bowel disease in an Australian cohort.Liver Int. 2017; 37 (Epub 2017 Jan 24. PMID: 27891750): 442-448https://doi.org/10.1111/liv.13328
- Declining risk of colorectal cancer in inflammatory bowel disease: an updated meta-analysis of population-based cohort studies.Inflamm Bowel Dis. 2013; 19: 789-799https://doi.org/10.1097/MIB.0b013e31828029c0
- Dutch initiative on Crohn and colitis (ICC). Prognostic factors for advanced colorectal neoplasia in inflammatory bowel disease: systematic review and meta-analysis.Gastroenterology. 2021; 160 (Epub 2020 Dec 29. PMID: 33385426): 1584-1598https://doi.org/10.1053/j.gastro.2020.12.036
- Liquid biopsies and cancer omics.Cell Death Dis. 2020; 6 (PMID: 33298891; PMCID: PMC7691330): 131https://doi.org/10.1038/s41420-020-00373-0
- European Crohn's and Colitis Organisation (ECCO). European evidence based consensus on surgery for ulcerative colitis.J Crohns Colitis. 2015; 9 (Erratum in: J Crohns Colitis. 2022 Aug 16;: PMID: 25304060): 4-25https://doi.org/10.1016/j.crohns.2014.08.012
- Colorectal cancer in patients with inflammatory bowel disease after liver transplantation for primary sclerosing cholangitis.Transplantation. 2003; 75 (PMID: 12829898): 1983-1988https://doi.org/10.1097/01.TP.0000058744.34965.38
- Incidence and outcome of colorectal cancer in liver transplant recipients: a national, multicentre analysis on 8115 patients.Liver Int. 2019; 39 (Epub 2018 Nov 9. PMID: 30129181): 353-360https://doi.org/10.1111/liv.13947
- European Crohn's and colitis organisation [ECCO] and the European society of gastrointestinal and abdominal radiology [ESGAR]. ECCO-ESGAR guideline for diagnostic assessment in IBD Part 1: initial diagnosis, monitoring of known IBD, detection of complications.J Crohns Colitis. 2019; 13 (PMID: 30137275): 144-164https://doi.org/10.1093/ecco-jcc/jjy113
- Colonoscopy surveillance in liver transplant recipients for primary sclerosing cholangitis associated with inflammatory bowel disease.Transplant Proc. 2020; 52 (Epub 2020 May 20. PMID: 32446687): 2484-2486https://doi.org/10.1016/j.transproceed.2020.01.116
- Progressive primary sclerosing cholangitis requiring liver transplantation is associated with reduced need for colectomy in patients with ulcerative colitis.Clin Gastroenterol Hepatol. 2012; 10 (Epub 2012 Jan 13. PMID: 22245961): 540-546https://doi.org/10.1016/j.cgh.2012.01.006
- Percutaneous liver biopsy using an ultrasound-guided subcostal route.Dig Dis Sci. 2001; 46 (PMID: 11270776): 128-132https://doi.org/10.1023/a:1005571904713
- Characteristics of early-onset vs late-onset colorectal cancer: a review.JAMA Surg. 2021; 156 (Erratum in: JAMA Surg. 2021 Sep 1;156(9):894. PMID: 34190968): 865-874https://doi.org/10.1001/jamasurg.2021.2380
- Timing of restorative proctectomy following subtotal colectomy in patients with inflammatory bowel disease.Colorectal Dis. 2006; 8 (PMID: 16630230): 278-282https://doi.org/10.1111/j.1463-1318.2005.00933.x
- Sexual and bladder dysfunction after total mesorectal excision for benign diseases.Scand J Gastroenterol Suppl. 2000; (PMID: 11232492): 48-51
- Postoperative steroid taper is associated with pelvic sepsis after ileal pouch-anal anastomosis.Inflamm Bowel Dis. 2019; 25 (PMID: 30597024): 1383-1389https://doi.org/10.1093/ibd/izy388
- Risk factors associated with portomesenteric venous thrombosis in patients undergoing restorative proctocolectomy for medically refractory ulcerative colitis.Colorectal Dis. 2016; 18 (PMID: 26773547): 393-399https://doi.org/10.1111/codi.13275
- Towards tolerance in liver transplantation.Best Pract Res Clin Gastroenterol. 2021; 54–55 (Epub 2021 Oct 14. PMID: 34874844)101770https://doi.org/10.1016/j.bpg.2021.101770
- Single access laparoscopic ileocecal resection in complicated Crohn's disease.Surg Innovat. 2010; 17 (Epub 2010 Sep 3. PMID: 20817639): 359-360https://doi.org/10.1177/1553350610382014
- Ischemic preconditioning protects intestine from prolonged ischemia.Transplant Proc. 2004; 36 (PMID: 15050134): 283-285https://doi.org/10.1016/j.transproceed.2004.01.078
- Post-operative recurrence of Crohn's disease: a prospective study at 5 years.Dig Liver Dis. 2016; 48 (Epub 2016 Jan 29. PMID: 26905749): 489-494https://doi.org/10.1016/j.dld.2016.01.009
- Cancer predictive studies.Biol Direct. 2020; 15 (PMID: 33054808; PMCID: PMC7557058): 18https://doi.org/10.1186/s13062-020-00274-3
- Management of low rectal cancer complicating ulcerative colitis: proposal of a treatment algorithm.Cancers. 2021; 13 (PMID: 34068058; PMCID: PMC8152518): 2350https://doi.org/10.3390/cancers13102350
- The Italian Society of Colorectal Surgery (SICCR). Inflammatory bowel disease (IBD) position statement of the Italian Society of Colorectal Surgery (SICCR): general principles of IBD management.Tech Coloproctol. 2020; 24 (Epub 2020 Jan 25. Erratum in: Tech Coloproctol. 2020 Jun 20;: PMID: 31983044): 105-126https://doi.org/10.1007/s10151-019-02145-0
- Proctocolectomy without ileostomy for ulcerative colitis.Br Med J. 1978; 2 (PMID: 667572; PMCID: PMC1605901): 85-88https://doi.org/10.1136/bmj.2.6130.85
- Laparoscopic versus open ileo-colonic resection in Crohn's disease: short- and long-term results from a prospective longitudinal study.J Gastrointest Surg. 2008; 12 (Epub 2007 Nov 20. PMID: 18027061): 1094-1102https://doi.org/10.1007/s11605-007-0394-6
- Elective staged proctocolectomy and living donor liver transplantation for colon cancer with sclerosing cholangitis-related ulcerative colitis: a case report.Surg Case Rep. 2020 Nov 1; 6 (PMID: 33130979; PMCID: PMC7604274): 278https://doi.org/10.1186/s40792-020-01059-6
- Proctocolectomy for colon cancer associated with ulcerative colitis a few months after living donor liver transplantation for primary sclerosing cholangitis: report of a case.Surg Today. 2009; 39 (Epub 2009 Jan 8. PMID: 19132471): 59-63https://doi.org/10.1007/s00595-008-3779-6
- Ileal pouch-anal anastomosis and liver transplantation for ulcerative colitis complicated by primary sclerosing cholangitis.Br J Surg. 2008; 95 (PMID: 18496886): 882-886https://doi.org/10.1002/bjs.6210
- Impact of ileal pouch-anal anastomosis on the surgical outcome of orthotopic liver transplantation for primary sclerosing cholangitis.J Crohns Colitis. 2013; 7 (Epub 2012 Jul 11. PMID: 22789675): 230-238https://doi.org/10.1016/j.crohns.2012.06.001
- Loop ileostomy closure after restorative proctocolectomy: outcome in 1,504 patients.Dis Colon Rectum. 2005; 48 (PMID: 15714246): 243-250https://doi.org/10.1007/s10350-004-0771-0
- Non-invasive techniques for assessing postoperative recurrence in Crohn's disease.Dig Liver Dis. 2008; 40 (PMID: 18598999): S265-S270https://doi.org/10.1016/S1590-8658(08)60536-8
- Endoscopic vs ultrasonographic findings related to Crohn’s disease recurrence: a prospective longitudinal study at 3 years.J Crohns Colitis. 2010; 4 (319-28 Epub 2010 Feb 19)https://doi.org/10.1016/j.crohns.2009.12.010
- Modified two-stage ileal pouch-anal anastomosis results in lower rate of anastomotic leak compared with traditional two-stage surgery for ulcerative colitis.J Crohns Colitis. 2016; 10 (Epub 2016 Mar 7. PMID: 26951468): 766-772https://doi.org/10.1093/ecco-jcc/jjw069
- Increasing incidence of pelvic sepsis following ileal pouch-anal anastomosis for ulcerative colitis in Denmark: a nationwide cohort study.Dis Colon Rectum. 2019; 62 (PMID: 31162379): 965-971https://doi.org/10.1097/DCR.0000000000001404
- All the other 126 contributing centers (www.eltr .org) and the European Liver and Intestine Transplant Association (ELITA). 2018 Annual Report of the European Liver Transplant Registry (ELTR) - 50-year evolution of liver transplantation.Transpl Int. 2018; 31 (PMID: 30259574): 1293-1317https://doi.org/10.1111/tri.13358
- Preoperative hypoalbuminemia is associated with adverse outcomes after ileoanal pouch surgery.Inflamm Bowel Dis. 2012; 18 (Epub 2011 Aug 29. PMID: 22605611): 1034-1041https://doi.org/10.1002/ibd.21842
- Prognostic modeling of preoperative risk factors of pouch failure.Dis Colon Rectum. 2012; 55 (PMID: 22426262): 393-399https://doi.org/10.1097/DCR.0b013e3182452594
- The outcome after restorative proctocolectomy with or without defunctioning ileostomy.Dis Colon Rectum. 2006; 49 (PMID: 16518581): 470-477https://doi.org/10.1007/s10350-006-0509-2
- Characteristics of learning curve in minimally invasive ileal pouch-anal anastomosis in a single institution.Surg Endosc. 2017; 31 (Epub 2016 Jul 12. PMID: 27412123): 1083-1092https://doi.org/10.1007/s00464-016-5068-6
- Adenocarcinoma in an ileoanal pouch formed for ulcerative colitis in a patient with primary sclerosing cholangitis and a liver transplant: report of a case and review of the literature.Dis Colon Rectum. 2006; 49 (PMID: 16601856): 909-912https://doi.org/10.1007/s10350-006-0517-2
- Ileoanal pouch cancers in ulcerative colitis and familial adenomatous polyposis: a systematic review and meta-analysis.Dig Liver Dis. 2022; 54 (Epub 2022 Jul 9. PMID: 35817683): 1328-1334https://doi.org/10.1016/j.dld.2022.06.013
- Proctocolectomy-ileal pouch-anal anastomosis for ulcerative colitis after liver transplantation for primary sclerosing cholangitis: a multi-institutional analysis.J Gastrointest Surg. 2008; 12 (Epub 2008 May 1. PMID: 18449613): 1221-1226https://doi.org/10.1007/s11605-008-0528-5
- The impact of ileal pouch-anal anastomosis on graft survival following liver transplantation for primary sclerosing cholangitis.Aliment Pharmacol Ther. 2018; 48 (Epub 2018 Jun 8. PMID: 29882252): 322-332https://doi.org/10.1111/apt.14828
- Intraoperative, postoperative and reoperative problems with ileoanal pouches.Br J Surg. 2012; 99 (Epub 2012 Feb 3. PMID: 22307828): 454-468https://doi.org/10.1002/bjs.8697
- Vascular complications after deceased and living donor liver transplantation: a single-center experience.Transplant Proc. 2010; 42 (PMID: 20430192): 865-870https://doi.org/10.1016/j.transproceed.2010.02.037
- Superior mesenteric vein thrombosis after colectomy for inflammatory bowel disease: a not uncommon cause of postoperative acute abdominal pain.Dis Colon Rectum. 2003; 46 (PMID: 12792441): 643-648https://doi.org/10.1007/s10350-004-6625-y
- Portal vein thrombi after ileal pouch-anal anastomosis: its incidence and association with pouchitis.Surg Today. 2007; 37 (Epub 2007 Jun 26. PMID: 17593473): 552-557https://doi.org/10.1007/s00595-006-3470-8
- Postoperative portomesenteric venous thrombosis: lessons learned from 1,069 consecutive laparoscopic colorectal resections.World J Surg. 2014; 38 (PMID: 24240673): 976-984https://doi.org/10.1007/s00268-013-2336-7
- Restorative surgery after colectomy for ulcerative colitis in England and Sweden: observations from a comparison of nationwide cohorts.Colorectal Dis. 2018; 20 (Epub 2018 Apr 19. PMID: 29603863): 804-812https://doi.org/10.1111/codi.14113
- Ileorectal anastomosis in comparison with ileal pouch anal anastomosis in reconstructive surgery for ulcerative colitis--a single institution experience.J Crohns Colitis. 2014 Jul; 8 (Epub 2013 Dec 5. PMID: 24315777): 582-589https://doi.org/10.1016/j.crohns.2013.11.014
- Long-term follow-up after ileorectal anastomosis for ulcerative colitis: a GETAID/GETAID chirurgie multicenter retrospective cohort of 343 patients.Ann Surg. 2017; 266 (PMID: 27655238): 1029-1034https://doi.org/10.1097/SLA.0000000000002022
- Primary versus staged reconstruction and risk of surgical failure in patients with ulcerative colitis: a nation-wide cohort study.Inflamm Bowel Dis. 2022; 28 (PMID: 34792582): 1301-1308https://doi.org/10.1093/ibd/izab263
- Pregnancy after liver transplantation: a case series and review of the literature.J Matern Fetal Neonatal Med. 2021; 34 (Epub 2019 Oct 21. PMID: 31635500): 3269-3276https://doi.org/10.1080/14767058.2019.1680632
- Risk of rectal neoplasia after colectomy and ileorectal anastomosis for ulcerative colitis.J Crohns Colitis. 2017; 11 (PMID: 28333202): 930-935https://doi.org/10.1093/ecco-jcc/jjx027
- Restorative surgery in patients with primary sclerosing cholangitis and ulcerative colitis following a colectomy.Inflamm Bowel Dis. 2018; 24 (PMID: 29462381): 624-632https://doi.org/10.1093/ibd/izx048
- Colectomy for patients with ulcerative colitis and primary sclerosing cholangitis - what next?.J Crohns Colitis. 2014; 8 (Epub 2013 Nov 12. PMID: 24239402): 421-430https://doi.org/10.1016/j.crohns.2013.10.008
- Inflammatory bowel disease position statement of the Italian Society of Colorectal Surgery (SICCR): ulcerative colitis.Tech Coloproctol. 2020; ([Epub ahead of print] PMID: 32124113)https://doi.org/10.1007/s10151-020-02175-z
- Selvaggi FInflammatory bowel disease position statement of the Italian society of colorectal surgery (SICCR): crohn's disease.; Italian society of colorectal surgery SICCR.tech coloproctol.2020https://doi.org/10.1007/s10151-020-02183-z ([Epub ahead of print] PMID: 32172396)
- Laparoscopic total colectomy with brooke ileostomy for chronic ulcerative colitis after orthotopic liver transplantation for primary sclerosing cholangitis.Dis Colon Rectum. 2014 Jun; 57 (PMID: 24807606): 800https://doi.org/10.1097/DCR.0000000000000133
- Laparoscopic total colectomy for ulcerative colitis after liver transplantation is feasible.J Minimal Access Surg. 2017; 13 (PMID: 28607292; PMCID: PMC5485814): 222-224https://doi.org/10.4103/0972-9941.199211
- Segmental colectomy for ulcerative colitis: is there a place in selected patients without active colitis? An international multicentric retrospective study in 72 patients.J Crohns Colitis. 2020; 14 (PMID: 32498084): 1687-1692https://doi.org/10.1093/ecco-jcc/jjaa107
Article info
Publication history
Published online: May 13, 2023
Accepted:
April 27,
2023
Received in revised form:
March 13,
2023
Received:
December 30,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
