Half-Century Follow-up after coffey diversion in early Childhood; Risk for Colorectal Carcinoma
Abstract Purpose It is well known, there is an increased risk of developing colorectal carcinoma after a Coffey diversion. The aim of the present study was to analyse the time course of this development. Material and Methods Twenty-five children between the ages of 2 months and 8 years were operated on from 1944 to 1961. The reason for urinary diversion was bladder exstrophy in 21 cases, myelomeningocele 2 and other diagnoses in 2. The retrospective study was based on data from patient files. Results After 50 years, almost all patients are rediverted to a Bricker conduit or Kock pouch due to hydronephrosis, upper urinary tract infections or risk for colorectal carcinoma. Only two patients still have a functioning Coffey. Five out of 25 patients are deceased, three from histologically verified colorectal cancer. One patient died from urinary sepsis four days after surgery and one for unknown reason 37 years after surgery. Three of the surviving patients have been treated for colorectal carcinoma. Thus, altogether 6 of the 25 patients (24%) have suffered from this kind of malignancy. The colorectal carcinoma developed in 2 patients when they still were diverted with the Coffey technique. However, the colorectal carcinoma occurred 2 years after rediversion to a Bricker conduit in one patient, 16 years there after in another one, and 20 years there after in a further 2 patients. Conclusions The risk of developing colorectal carcinoma persists for many years after rediversion which calls for life time follow-up with regular colonoscopies.