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Master Thesis

Maladies Inflammatoires Chroniques Intestinales et Cancer colorectal : facteurs de risque et résultats ontologiques à long terme

Abstract : Inflammatory Bowel Diseases (IBD) are a well-known risk-factor for colorectal cancer (CRC). Despite guidelines for colonoscopy screening for dysplasia, cancer sometimes occurs. Actually, IBD-associated CRC (IBD-CRC) is not yet well-known and surgical strategy is not self-apparent. Aims : To precise IBD-CRC prognosis, to define IBD-CRC risk-factors in a surgical pre- operative setting, and to assess IBD-CRC surgical strategies and post-operative outcomes. Methods : Retrospective, monocentric study. Colorectal resections for colic-IBD were rewieved and cases with CRC were retrieved in order to look for risk factors. They were matched with sporadic CRC operated on with similar characteristics. Results : Between 2004 and 2014, 643 patients with IBD were operated on : 503 for intestinal resections, 192 for colonic disease. 21 patients (4%) were diagnosed with CRC. Risk factors for IBD-related CRC were primary sclerosing cholangitis (p=0,001), pancolitis (p=0,04), extra-digestive symptoms (p=0,008), prior colorectal resection (p=0,02), lack of treatment with immunosuppressive or anti-TNF drugs (p=0,01), endoscopic mucosal healing (p=0,001). When compared with 63 patients with sporadic CRC (S-CRC), patients with IBD-CRC were younger (p=0,001), non-smokers (p=0,03). Multifocal lesions were more frequent (14% ; p=0,04). When operated, surgery was more extended (p=0,001), lymphadenectomy not systematic (80%), sphincterian preservation for rectal tumour was less usual (p=0,04) and hospital stay was longer. (p=0,003). Morbimortality differences were not significant. Overall (5-years : 80%) and disease-specific survival were not different between S-CRC and IBD-CRC (p=0,845) Conclusion : IBD-CRC is a rare disease. Knowledge of risk-factors, by estimate CRC probability, may help to detect CRC on pre-operative setting, as endoscopic screening too. When operated, prognosis is similar between IBD-CRC and sporadic-CRC.
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Master Thesis
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Submitted on : Thursday, December 17, 2015 - 4:20:02 PM
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Antoine Thicoïpé. Maladies Inflammatoires Chroniques Intestinales et Cancer colorectal : facteurs de risque et résultats ontologiques à long terme. Médecine humaine et pathologie. 2015. ⟨dumas-01245784⟩



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