Clin Colon Rectal Surg 2024; 37(01): 037-040
DOI: 10.1055/s-0043-1762562
Review Article

Cancer in the Anal Transition Zone and Ileoanal Pouch following Surgery for Ulcerative Colitis

Jennifer L. Miller-Ocuin
1   Division of Colorectal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
2   Department of Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
Jean H. Ashburn
2   Department of Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
› Author Affiliations


Restorative proctocolectomy with ileal pouch-anal anastomosis remains the gold standard treatment for patients with ulcerative colitis who desire restoration of intestinal continuity. Despite a significant cancer risk reduction after surgical removal of the colon and rectum, dysplasia and cancers of the ileal pouch or anal transition zone still occur and are a risk even if an anal canal mucosectomy is performed. Surgical care and maintenance after ileoanal anastomosis must include consideration of malignant potential along with other commonly monitored variables such as bowel function and quality of life. Cancers and dysplasia of the ileal pouch are rare but sometimes difficult-to-manage sequelae of pouch surgery.

Publication History

Article published online:
24 March 2023

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