**7.7 Pouch dysplasia/cancer: 1%**

About 1% of patients develop dysplasia or carcinoma after surgery, which occurs in the retained rectum, anal transitional zone, or ileal pouch, depending upon the procedure performed.

Mark-Christensen et al. analyzed 1723 patients with IPAA operated for ulcerative colitis in the period 1980–2010 that matched to 8615 individuals from the background population. They concluded that pouch cancer following IPAA is sporadic, questioning the need for general, rather than selective, surveillance. The overall cancer risk is comparable to that of the background population (**Figure 11**).

**Figure 11.**

*Nine years passed between RCP with IPAA for FAP. The residual polyps were appearing in IPAA, easily handled by endoscopic surveillance with polypectomy.*

The increased risk of hepatobiliary cancer is likely an effect of coexisting liver disease and not causally related to IPAA [42].
