Management of Ulcerative Colitis in Patients with Rectal Cancer

While medical therapy is the first line of treatment for ulcerative colitis (UC), proctocolectomy can provide a curative option. Approximately 20% of patients with ulcerative colitis will require surgery in their lifetime [1]. Indications for surgery are medically refractory disease, complicated disease, extraintestinal manifestations, toxic colitis, failure to thrive, dysplasia and cancer. In most cases, a restorative proctocolectomy with an ileal pouch-anal anastomosis (IPAA) is the preferred method to provide concurrent cure of ulcerative colitis and reconstruction of the gastrointestinal tract. The risk of developing colorectal cancer with ulcerative colitis over a lifetime is estimated between 5% and 13.5% [2]. In cases of ulcerative colitis complicated by rectal cancer, the choice of operative procedure becomes more challenging. An alternative to IPAA would be a total proctocolectomy with end ileostomy (TPC). In UC patients with rectal cancer, the need for neoadjuvant chemoradiation and adjuvant chemotherapy, in addition to other patient and disease dependent variables, may impact long term outcomes including overall survival and quality of life (Table 30.1).