Anal Squamous Cell Carcinoma in Ulcerative Colitis: Can Pouches Withstand Traditional Treatment Protocols?

BACKGROUND Anal squamous cell carcinoma has rarely been reported in the setting of ulcerative colitis. OBJECTIVE This study aimed to understand the prognosis of anal squamous cell carcinoma in the setting of ulcerative colitis. DESIGN This is a retrospective review. SETTING This study was conducted at a referral center. PATIENTS Adult patients with both ulcerative colitis (556.9/K51.9) and anal squamous cell carcinoma (154.3/C44.520) between January 1, 2000 and August 1, 2019 were included. MAIN OUTCOMES MEASURES The primary outcomes measured are treatment and survival of anal squamous cell carcinoma. RESULTS Of the 13,499 patients with ulcerative colitis treated, 17 adult patients with ulcerative colitis and anal dysplasia and/or anal squamous cell carcinoma were included in the study: 6 had a diagnosis of anal squamous cell carcinoma, 8 had high-grade squamous intraepithelial lesions, and 3 had low-grade squamous intraepithelial lesions. There were 4 men (23%) and a median age of 55 years (range, 32-69) years. At diagnosis, 6 had an IPAA, of which 5 had active pouchitis, 1 had an ileorectal anastomosis with active proctitis, 1 had a Hartmann stump with disuse proctitis, 5 had pancolitis, and 4 had left-sided colitis. Of the 6 with anal squamous cell carcinoma, all received 5-fluorouracil and mitomycin C with external beam radiation therapy. Four patients had an IPAA, all of whom required intestinal diversion or pouch excision because of treatment intolerance. At a median follow-up of 60 months, 3 patients died: one at 0 months (treatment-related myocardial infarction), one at 60 months (metastatic anal squamous cell carcinoma), and one at 129 months (malignant peripheral nerve sheath tumor); the remaining patients had no residual disease. LIMITATIONS This study was limited because of its retrospective nature and small number of patients. CONCLUSION Anal squamous cell carcinoma in the setting of ulcerative colitis is extremely rare. In the setting of IPAA, diversion may be necessary to prevent radiation intolerance. Careful examination of the perianal region should be performed at the time of surveillance endoscopy. See Video Abstract at http://links.lww.com/DCR/B582. CARCINOMA ANAL DE CLULAS ESCAMOSAS EN COLITIS ULCEROSA PUEDE EL POUCH MODIFICAR LOS RESULTADOS DE LOS PROTOCOLOS DE TRATAMIENTO TRADICIONAL ANTECEDENTES:La incidencia de cancer anal de celulas escamosas es muy baja en pacientes con colitis ulcerosa.OBJETIVO:Comprender el pronostico del cancer anal de celulas escamosas en el contexto de la colitis ulcerosa.DISENO:Revision retrospectiva.AJUSTE:Centro de referencia.PACIENTES:Pacientes adultos con colitis ulcerosa (556.9 / K51.9) y cancer anal de celulas escamosas (154.3 / C44.520) entre el 1 de enero de 2000 y el 1 de agosto de 2019.RESULTADOS PRINCIPALES:Tratamiento y sobrevida del cancer anal de celulas escamosas.RESULTADOS:De 13.499 pacientes en tratamiento por colitis ulcerosa, diecisiete presentaron displasia y/o cancer de celulas escamosas: 6 con cancer, 8 con lesiones intraepiteliales escamosas con displasia de alto grado y 3 con displasia de bajo grado.Cuatro son hombres (23 %) con una mediana de 55 anos (rango 32-69). Al realizar el diagnostico 6 tenian pouch, 5 con pouchitis activa; 1 con ileorecto anastomosis con proctitis activa y 1 con operacion de Hartman y munon con colitis por desuso; ademas 5 tenian pancolitis y 4 tenian colitis izquierdaTodos los casos con cancer anal de celulas escamosas (6 pacientes), fueron tratados con 5-FU mas Mitomicina y radioterapia externa. Cuatro pacientes tenian pouch, todos requirieron derivacion intestinal o escision del pouch por intolerancia al tratamiento.En la mediana de seguimiento de 60 meses, tres pacientes fallecieron: uno a los 0 meses (infarto de miocardio relacionado con el tratamiento), uno a los 60 meses (cancer de celulas escamosas metastasico) y uno a los 129 meses (tumor maligno de la vaina del nervio periferico); el resto no presentaba enfermedad residual.LIMITACIONES:Revision retrospectiva, numero pequeno de pacientes.CONCLUSION:El cancer anal de celulas escamosas en el contexto de la colitis ulcerosa es extremadamente raro. En el contexto de IPAA, la derivacion puede ser necesaria para prevenir la intolerancia a la radiacion. Se debe realizar un examen cuidadoso de la region perianal en el momento de la endoscopia de control. Consulte Video Resumen en http://links.lww.com/DCR/B582.