Long-standing UC is a predisposing factor for development of CRC, as it is clear that cancer is more common in these patients compared to the age-matched general population [19, 20]. The actual prevalence varies in different series [21, 22], and the cumulative probability of developing CRC is 18% after 30 years of disease . In addition to disease duration, dis ease extent also correlates with an increased risk of cancer, with the risk being most significant in patients with pancolitis . Another two independent risk factors for CRC in UC patients are family history of CRC [25, 26] and primary sclerosing cholangitis (PSC) . Common practice is to start an annual or biannual surveillance colonoscopy, as cancer risk increases over that of the background population. This would usually mean 8-12 years after disease onset for patients with pancolitis or upon diagnosis of concomitant PSC. Confirmed precancerous lesions, such as high-grade dysplasia or dysplasia-associated lesion or mass (DALM) would be an indication for proctocolectomy [28, 29]. In most inflammatory bowel disease (IBD) referral centres, confirmed low-grade dysplasia would also be an indication for surgery  although strict follow-up is an optional alternative suggested by others .
Diagnosis of already existing colorectal carcinoma is an obvious indication for surgery, and if curable intent is possible, surgery should include removal of the entire colon and rectum, as the presence of one proven cancer puts the patient in a significant risk of having a synchronous or developing a metachronous carcinoma . In patients with good operative risk and adequate anal sphincter mechanism, IPAA is the most suitable procedure for cancer prophylaxis as well as preservation of reasonable quality of life.
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