An important issue is the fate of the rectum after subtotal colectomy for UC or Crohn's disease. Johnson et al.  studied a series of 1439 patients with UC. A surgical resection was performed in 374 patients (26%); 172 patients underwent subtotal colectomy with mucous fistula. Ten patients (3.6%) developed a rectal cancer. In this study the cumulative risk of developing a rectal cancer in the rectal stump reached 17% 27 years after disease onset.
A similar study by Oakley et al.  on 288 patients having a subtotal colectomy for UC showed four patients (1.4%) who developed a cancer in the rectal stump.
Winther et al.  studied 42 patients with a closed rectal stump after surgery for UC or Crohn's disease. The median duration of the disease was 8.3 years (1.3-34 years). The Authors showed no endoscopic or histological signs of dysplasia or carcinoma and no mutation of p53 gene in any biopsy or lavage fluid. However, 78% and 43% of the patients showed moderate to severe mucosal inflammation and rectal stump involution respectively. For this reason a role of adjuvant markers to improve cancer surveillance in this subgroup of patients is advocated.
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