Bladder substitutes, bile acids and the risk of colorectal cancer: an experimental study

There is a large body of evidence relating the causation of colon cancer to bile acids. Using an animal model, we attempted to address the question, i.e., the incidences of carcinogenesis in the colon as consequences of resection of different bowel segments, predominantly employed in the construction of various forms of intestinal bladder substitutes. 60 male Wistar rats were operated. Group 1 served as control, in group 2, 20 cm of terminal ileum was resected, and rats in group 3 underwent resection of the distal 10 cm of the ileum and 7 cm of the proximal colon. All rats were killed 6 months after surgery and the colon was removed. After examination under 40-fold magnification, in the absence of tumors, 3 biopsies were performed at predetermined positions and underwent histological processing. Even if no tumor was found it would be incorrect to conclude that these results would have an appeasing relevance. The complex and highly different fecal bile acid profiles of the rat compared to man makes it impossible in this context to draw analogies between the rat model and human colonic carcinogenesis. Furthermore, 6 months of observation in the rat might be too short for 'spontaneous' colonic carcinogenesis. Nevertheless, there exists evidence from epidemiological studies to implicate bile acids as an etiological factor in the development and growth of colorectal cancer. Therefore, the importance of colorectal cancer in urologic surgery patients must be kept in perspective. In this direction, further studies are required besides the application of known appropriate preventive measures.