Inflammatory bowel disease associated neoplasia: A surgeon’s perspective

Table 1 Risk factors for the development of inflammatory bowel disease associated colorectal cancer

Risk Factors for IBD-CRC
Older age of onset of IBD
Duration of disease
Extent of disease
Severity of inflammation
Primary Sclerosing cholangitis
Family History of CRC

CRC: Colorectal cancer; IBD: Inflammatory bowel disease.

Table 2 Kudo criteria

Pit type	Description	Pit size (mm)	Associated histological findings
I	Round (normal)	0.07 (0.02)	Non-neoplastic
II	Papillary/Stella	0.09 (0.02)	Hyperplastic
IIIs	Round or tubular (small)	0.03 (0.01)	Neoplastic
IIIL	Round or tubular (large)	0.22 (0.09)	Neoplastic
IV	Gyrus-like	0.93 (0.32)	Neoplastic
V(a)	Amorphous structure/irregular arrangement	NA	Invasive cancer

Table 3 Recommended procedures for patients with inflammatory bowel disease-associated neoplasia

Procedure type	Indications	Relative contraindications
Total proctocolectomy with end ileostomy	UC, CD refractory disease or neoplasia	None
Restorative proctocolectomy (RP) with Ileoanal pouch	UC	Fecal incontinence
		Direct sphincter invasion by tumor
		Stage IV CRC
Subtotal colectomy with ileorectal anastomosis	UC or CD with contraindication for RP	Rectal neoplasia
		Active rectal inflammation
Segmental resection	UC or CD with Unifocal dysplasia or cancer and no active disease	Acute or chronic colonic inflammation
	CRC with comorbidity and age > 65 yr
Diverting ostomy	UC or CD with Stage IV CRC with obstruction and/or severe comorbidity	None

RP: Restorative proctocolectomy; UC: Ulcerative colitis; CD: Crohn’s disease.

Table 4 Complications of restorative proctocolectomy

Anastomotic failure	5%-10%[81,82]
Pelvic abscess	4.8%-8%[101,102]
Perianal abscess and perianal fistula	7%[103]
Pouch fistula	4%[104]
Anastomotic strictures	10%-40%[104,105]
Sexual dysfunction	3.4%[81]
Pouchitis	19%-26%[81,82]
Cuffitis	15%[79]

Table 5 Risk Factors for pouch neoplasia

History of preoperative or intraoperative diagnosis of UC-associated dysplasia or cancer

Presence of type C mucosa of the pouch

Concurrent PSC

Family history of colon cancer

Long duration of UC

History of chronic pouchitis

PSC: Primary sclerosing cholangitis; UC: Ulcerative colitis.

Table 6 Prognosis and long-term outcomes of inflammatory bowel disease - colorectal cancer

Ref.	Cancer type	n	5-yr overall survival
Hrabe et al[106]	IBD-CRC	55	54.5%
	Sporadic-CRC	109	62.2%
Renz et al[107]	IBD-CRC	33	49%
	Sporadic-CRC	165	67%
Delaunoit et al[99]	IBD-CRC	290	54%
	Sporadic-CRC	290	53%
Kiran et al[108]	IBD-CRC	240	77%
	Sporadic-CRC	480	72%

CRC: Colorectal cancer; IBD: Inflammatory bowel disease.