Long Term Risk of Cancer Development in the Pelvic Pouch

Adaptive alterations, both morphological and phlogistic, in the reservoir mucosa characterised by vil-lous atrophy and crypt hyperplasia [56], and the report that some cases of dysplasia and cancer were found in ileal pouches [57, 58] caused concern that patients with IPAA might run the same risk in the long term as patients with long-lasting UC [46]. However, the supposed mucosal atrophy - dysplasia -cancer sequence [58] is not incontrovertibly corroborated, as the adaptation of the ileal mucosa is phe-notypical and subject to regression after control of chronic inflammation [59]. It is a much-debated subject [60] whether carcinoma development is directly ascribable to the pouch mucosa or to the residual rectal mucosa whatever anastomotic technique is used, as pointed out in various studies [57, 61, 62].

Two recent studies [63,64] one with a follow-up of 30 years [63], show that the development of dysplas-tic mucosal lesions of ileoanal reservoirs or Kock pouch is very low, ranging from 0 to 1.6% [63-65]. Further and more detailed data are necessary to confirm whether patients with serious villous atrophy and chronic pouchitis represent a subgroup with a particular risk of malignancy, as suggested by a Swedish study [58]. In the group of patients with FAP who underwent IPAA, the risk of developing adenomas in the reservoir is deemed 35% after 10 years and 75% after 15 years [66].

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