5^ Congresso Nazionale Siccr “Dalle Personal Opinions All’evidence Based Surgery” – Lecce - Relatore su “Pro e contro la mucosectomia” nell’ambito della tavola rotonda “La colite ulcerosa acuta severa: trattamento medico o chirurgico?”

BACKGROUND Ano-rectal carcinoma arising on chronic perianal fistula is rare in Crohn’s Disease (CD). However, it is characterized by a challenging diagnosis, advanced stage at surgery and poor prognosis. Details of patients with CD who developed anal carcinoma associated with a perianal fistula are presented along with a brief literature review. METHODS We retrospectively investigated patients who underwent surgery for CD between 2007 and 2013 at our institution. Patients with diagnosis of anal carcinoma associated with fistulae were identified and medical records evaluated. RESULTS Case 1 - A 31 year-old female with a 13-years history of perineal CD and terminal ileitis underwent EUA for transphyncteric fistula refractory to previous treatment. Multiple biopsies demonstrated mucinous anal adenocarcinoma. An abdomino-perineal resection extended to posterior vaginal wall and coccyx, inguinal linfectomy and ileocecal resection were performed. Pathology report showed T4bN0 tumor (R1). She received postoperative chemotherapy and also steroids for exacerbation of ileal CD. At 41 months follow-up, a pelvic recurrence was detected and chemo-radiotherapy planned.....