The endorectal ileal pullthrough procedure in patients with ulcerative colitis and familial polyposis with carcinoma

Since 1977, 196 patients (177 with ulcerative colitis and 19 with familial polyposis) have undergone colectomy, mucosal proctectomy and endorectal ileal pull-through with or without an ileal reservoir (PTR) at UCLA Medical Center. Fourteen of the patients (7.1 per cent) had carcinoma of the colon or rectum at the time of operation; 12 had colitis and two, polyposis. Another 40 patients had mucosal dysplasia. Only five of the 14 patients with carcinoma were diagnosed before operation despite close surveillance by gastroenterologists. The mean duration of colitis before the diagnosis of carcinoma was made was 17 years; the mean age that the carcinoma was identified was 38 years. Eleven of the 12 patients with colitis had universal involvement. Two patients with colitis and carcinoma who underwent colectomy and PTR died a mean of 30.5 months postoperatively of metastatic disease. Twelve patients with carcinoma (ten with colitis and two with polyposis) are alive a mean of 29 months postcolectomy and PTR; two of these have received chemotherapy. The low mortality (0.4 per cent) and good clinical results after colectomy and the PTR procedure and the unexpectedly high incidence of carcinoma and mucosal dysplasia among patients referred for operation suggest that surgical treatment should be considered at an earlier stage than the current general practice, particularly in patients at high risk (mucosal dysplasia, pancolitis and duration of more than ten years).