P274 Malignancy in perianal Crohn’s disease
F. Ficari*1, S. Scaringi1, F. Giudici1, D. Zambonin1, C. Di Martino1, F. Tonelli2, P. Bechi1
1Careggi University Hospital, Surgery and Translational Medicine, Florence, Italy, 2University of Florence, Florence, Italy
The incidence of anorectal adenocarcinoma arising at long-standing anorectal fistulas in Crohn’s disease (CD) seems to be low, but few data are available in literature. The aim of this study is to describe our experience on this topic
A cross-searching analysis between the histopathologic database and the surgical report registry of our Department has been performed from 1990 to 2015. Characteristics of the patients and of the disease were recorded (age at diagnosis of cancer, age at diagnosis of CD, site of the disease, extent of the disease, previous medical therapy, etc.). Diagnostic examination was performed under general anaesthesia, and biopsies or curettage for pathological confirmation was obtained in all cases. The surgical treatment aimed to the complete removal of cancer tissue through an abdomino-perineal amputation according to Miles. Follow-up was recorded every 6 months
Between 1990 and 2015, 480 patients underwent surgical treatment for perianal CD in our centre. Within this cohort, 7 patients (1.46%) developed anal adenocarcinoma all after a long-standing perianal disease (mean = 3.2 years, range 5–23). They were 2 males (28.6%) and 5 females (71.4%), mean aged 47.8 years (range 42–60 years). Diagnosis of CD had been performed a mean of 16.7 years before (range 17–35); localisation of CD was respectively colonic in 3 cases, ileo-colic in 3, and ileal in 1 patient. A Miles procedure was performed in 5 cases, whereas in a 60-year-old male and in a 51-year-old female, both affected by advanced cancer with severe comorbidities and a very poor performance status, only a diverting stoma was performed. Ano-rectal stenosis was present in 4 patients (57.1%); tumour staging was respectively T3 N0 in 3 patients; T4NX in 2 patients; and T4N1 and T4N2 in the remaining 2. During the previous year from diagnosis, immunosuppressive therapy with AZA had been performed only in 1 patient, whereas another 1 had been under infliximab during the same period. Five patients died after 8, 12, 31, 40, and 43 months after surgery because of local recurrence or metastatic disease. Further, 1 patient died because of heart failure 20 months after surgery without any evidence of recurrence; 1 patient is disease free after more than 5 years from surgery
Malignancy in perianal CD is rare but possible. It develops long time after the first symptoms; prognosis is bad, but an aggressive surgical treatment could be useful, especially for those cases without lymph node metastases.