Surgical management of ulcerative colitis-associated colorectal cancer in a 20-year period, a single-centre study

Introduction: The incidence of inflammatory bowel disease is on the rise. Inflammation that persists for years or decades may involve the risk of malignant transformation. Indeed, it is the cause of death in 15% of the UC patient population. Proctocolectomy followed by ileal pouch-anal anastomosis is the accepted surgical procedure. Aim: Our study objective was to retrospectively assess the occurrence and surgical treatment of UC-associated colorectal cancer cases in our institute and analyse survival data. Materials and methods: In our department, 39 patients (12 female and 27 male patients) underwent surgery for UC-associated colorectal cancer between 1 January 2005 and 1 January 2025. Their mean age was 55 ± 13.4 years. Risk factors for the disease, examination results, types of surgery, perioperative and long-term surgical results, and survival measures were assessed retrospectively. The latter were determined using the Kaplan-Meier analysis. Results: Thirty-nine patients were diagnosed with UC at a mean age of 35.7 ± 16.7 years, and an average of 19.4 ± 12.3 years passed between the diagnosis of UC and the first surgical intervention. Regular endoscopies were performed in only 66% of our patients. Preoperative staging confirmed distant metastases in 12 patients (30.7%). Patients underwent 34 elective and 5 emergency surgeries. The mean follow-up duration was 40.2 ± 51.7 months. Only 7 patients (17.9%) had a T1 lesion. Lymph node involvement was confirmed in 17 cases (44.5%), whereas 12 patients (30.7%) showed dissemination. Adjuvant chemotherapy was administered in 23 cases (58.9%), and follow-up was recommended for 13 patients (33.3%). During the study period, 17 of the 39 patients died. The mean survival after the surgical procedure was 98.6 months (8.2 years). Survival was significantly shorter in patients who had undergone emergency surgery, were active smokers, suffered from PSC, and lacked gastroenterological follow-up. Conclusion: Based on our experience, it is especially important for UC patients to receive close gastroenterological follow-up in specialised centres and undergo regular colonoscopies and for staff to evaluate biopsy samples properly and perform the appropriate surgical procedures in due time, preferably proctocolectomy and creation of IPAA with a minimally invasive method.