TY - JOUR
T1 - Perianal Fistulizing Crohn's Disease–Associated Anorectal and Fistula Cancers
T2 - Systematic Review and Expert Consensus
AU - Wong, Serre Yu
AU - Rowan, Cathy
AU - Brockmans, Elvira Diaz
AU - Law, Cindy C.Y.
AU - Giselbrecht, Elisabeth
AU - Ang, Celina
AU - Khaitov, Sergey
AU - Sachar, David
AU - Polydorides, Alexandros D.
AU - Winata, Leon Shin han
AU - Verstockt, Bram
AU - Spinelli, Antonino
AU - Rubin, David T.
AU - Deepak, Parakkal
AU - McGovern, Dermot P.B.
AU - McDonald, Benjamin D.
AU - Lung, Phillip
AU - Lundby, Lilli
AU - Lightner, Amy L.
AU - Holubar, Stefan D.
AU - Hanna, Luke
AU - Hamarth, Carla
AU - Geldof, Jeroen
AU - Dige, Anders
AU - Cohen, Benjamin L.
AU - Carvello, Michele
AU - Bonifacio, Cristiana
AU - Bislenghi, Gabriele
AU - Behrenbruch, Corina
AU - Ballard, David H.
AU - Altinmakas, Emre
AU - Sebastian, Shaji
AU - Tozer, Phil
AU - Hart, Ailsa
AU - Colombel, Jean Frederic
N1 - Publisher Copyright:
© 2024 The Author(s)
PY - 2024
Y1 - 2024
N2 - Background & Aims: Perianal fistulizing Crohn's disease (PFCD)-associated anorectal and fistula cancers are rare but often devastating diagnoses. However, given the low incidence and consequent lack of data and clinical trials in the field, there is little to no guidance on screening and management of these cancers. To inform clinical practice, we developed consensus guidelines on PFCD-associated anorectal and fistula cancers by multidisciplinary experts from the international TOpClass consortium. Methods: We conducted a systematic review by standard methodology, using the Newcastle-Ottawa Scale quality assessment tool. We subsequently developed consensus statements using a Delphi consensus approach. Results: Of 561 articles identified, 110 were eligible, and 76 articles were included. The overall quality of evidence was low. The TOpClass consortium reached consensus on 6 structured statements addressing screening, risk assessment, and management of PFCD-associated anorectal and fistula cancers. Patients with long-standing (>10 years) PFCD should be considered at small but increased risk of developing perianal cancer, including squamous cell carcinoma of the anus and anorectal carcinoma. Risk factors for squamous cell carcinoma of the anus, notably human papilloma virus, should be considered. New, refractory, or progressive perianal symptoms should prompt evaluation for fistula cancer. There was no consensus on timing or frequency of screening in patients with asymptomatic perianal fistula. Multiple modalities may be required for diagnosis, including an examination under anesthesia with biopsy. Multidisciplinary team efforts were deemed central to the management of fistula cancers. Conclusions: Inflammatory bowel disease clinicians should be aware of the risk of PFCD-associated anorectal and fistula cancers in all patients with PFCD. The TOpClass consortium consensus statements outlined herein offer guidance in managing this challenging scenario.
AB - Background & Aims: Perianal fistulizing Crohn's disease (PFCD)-associated anorectal and fistula cancers are rare but often devastating diagnoses. However, given the low incidence and consequent lack of data and clinical trials in the field, there is little to no guidance on screening and management of these cancers. To inform clinical practice, we developed consensus guidelines on PFCD-associated anorectal and fistula cancers by multidisciplinary experts from the international TOpClass consortium. Methods: We conducted a systematic review by standard methodology, using the Newcastle-Ottawa Scale quality assessment tool. We subsequently developed consensus statements using a Delphi consensus approach. Results: Of 561 articles identified, 110 were eligible, and 76 articles were included. The overall quality of evidence was low. The TOpClass consortium reached consensus on 6 structured statements addressing screening, risk assessment, and management of PFCD-associated anorectal and fistula cancers. Patients with long-standing (>10 years) PFCD should be considered at small but increased risk of developing perianal cancer, including squamous cell carcinoma of the anus and anorectal carcinoma. Risk factors for squamous cell carcinoma of the anus, notably human papilloma virus, should be considered. New, refractory, or progressive perianal symptoms should prompt evaluation for fistula cancer. There was no consensus on timing or frequency of screening in patients with asymptomatic perianal fistula. Multiple modalities may be required for diagnosis, including an examination under anesthesia with biopsy. Multidisciplinary team efforts were deemed central to the management of fistula cancers. Conclusions: Inflammatory bowel disease clinicians should be aware of the risk of PFCD-associated anorectal and fistula cancers in all patients with PFCD. The TOpClass consortium consensus statements outlined herein offer guidance in managing this challenging scenario.
KW - Anorectal Cancer
KW - Inflammatory Bowel Disease
KW - Perianal Fistulizing Crohn's Disease
UR - http://www.scopus.com/inward/record.url?scp=85202457451&partnerID=8YFLogxK
U2 - 10.1016/j.cgh.2024.05.029
DO - 10.1016/j.cgh.2024.05.029
M3 - Review article
C2 - 38871152
AN - SCOPUS:85202457451
SN - 1542-3565
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
ER -