MANAGEMENT OF COLORECTAL NEOPLASIA DURING PREGNANCY OR IN THE
POSTPARTUM PERIOD
Erman Aytac, Gokhan Ozuner, Ozgen Isik, Emre Gorgun, Luca Stocchi
Department of Colorectal Surgery Digestive Disease Institute, Cleveland Clinic, Ohio
Background: Colorectal cancer during pregnancy is rare, but disease diagnosis and management in such
instances is extremely challenging. As two patients with possibly conflicting interests need to be managed,
many ethical, psycho emotional and medical issues need to be addressed simultaneously. This study reports
our experience in this group of patients. Methods: Patients who were diagnosed with colorectal cancer
during pregnancy, or in the immediate postpartum period, between August 1997 and April 2013, and who
were seen in our institution’s Department of Colorectal Surgery were included in the study. Patient
characteristics, operation, fetal heath and follow-up during pregnancy, type of delivery and oncologic
outcomes were analyzed. Results: Eight patients met our study criteria. Median age at the time of diagnosis
of colorectal cancer was 31 (24-38). Tumor histology was either adenocarcinoma (n=7) and carcinoid
tumor (n=1). Median follow-up after surgery was 36 months (0.2-192). The presenting symptoms, duration
of symptoms, tumor location and treatment strategy are listed in the table. Median duration of symptoms
before diagnosis was 18 weeks. Three patients were diagnosed with colorectal cancer during pregnancy and
underwent surgery prior to delivery. These cases included 1 anterior resection with an end colostomy in the
18th week, 1 low anterior resection in the 24th week and 1 subtotal colectomy with an end ileostomy during
the 8th week of pregnancy. Five patients were diagnosed with colorectal cancer within a median of 2.1
months after delivery. A synchronous low anterior resection and liver resection, an extensive left
colectomy, a transanal resection, an ileocecal resection, and a right colectomy were performed on those
patients. None of the patients received adjuvant treatment during pregnancy. No adverse neonatal outcomes
were noted. All deliveries were term, except for one patient who had a low anterior resection during
pregnancy (34th week) and delivered pre-term. Two patients underwent cesarean section. Conclusion: Most
cancers in this group of patients present at a later stage. There has been a significant delay in the diagnosis
of these tumors, which may affect overall prognosis. Surgical intervention did not adversely affect neonatal
or maternal outcomes in this group of patients. Patients with advanced disease died during or shortly after
delivery.
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