significance of total colectomy and eventual rectal cancer

[Morecambe]

You were kind enough to feature two questions which I posed about a year ago on 11/25/2004 and 12/30/2004 relating to the aftermath of a total colectomy following torrential rectal bleeding from diverticular disease.  At that time I was 59 years of age.

When one refers to "total colectomy" I assume that this can also be described as an "ileorectal anastomosis" (="IRA")?

I have scrutinised hundreds of medical articles posted on the internet which refer to the outcome and long term effects of the IRA procedure.  Many of these reports appear to suggest that there is a significantly increased risk of eventual rectal cancer in patients who have undergone IRA surgery in the past.  However (and I am not sure whether I have correctly interpreted these articles) it appears that this increased risk of rectal cancer is limited to cases where the reason for performing the total colectomy/IRA surgery was "FAP" (or similar).  In turn FAP appears to be associated with cancer of the large intestine and/or colon - is this correct?

I guess you can perceive where my question is heading...!!  Am I entitled to assume that, since my total colectomy/IRA was performed in order to eliminate a history of torrential diverticular bleeding, the risk of eventual cancer of the rectum is no greater than it would have been without the IRA surgery that I underwent in March 2004?

Or do I face an increased risk of rectal cancer solely by virtue of having undergone this surgical procedure?  Are there any regular tests/preventative screening against rectal cancer that I should consider?  Are there any other increased eventual risks/diseases to be aware of over the next 10-20 years following my total colectomy/IRA?

Many thanks in anticipation - and also for the excellent and informative responses on your Medhelp Gastroenterology Forum.

[Kevin Pho, MD]

The ileorectal anastomosis is done in conjunction with a total colectomy.  Once the colon is removed, the small bowel (ileum) is connected to the rectum (anastamosis).  

FAP is indeed associated with a significant risk of colon cancer.  The procedure itself is associated with an increased risk of rectal cancer - studies showing it to be as high as 17 percent long-term.

Tests to evaluate rectal cancer would include yearly stool guaiac testing as well as periodic endoscopies.  

Other complications can include bowel obstruction as well as leakage around the anastomsosis.

These considerations can be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
http://www.straightfromthedoc.com