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7, p=0.01) cancers were identified as independent risk factors for primary ATZ cancer. Four of 1970 (0.2%) patients developed de novo ATZ/pouch cancer and dysplasia. The 10-year estimated cumulative pouch survival rate was not significantly different between stapled IPAA and hand-sewn IPAA cases (95.9% and 97.3%, p=0.25). CONCLUSION The risk of de novo ATZ/pouch cancer and dysplasia was rare. The decision to perform a hand-sewn or a stapled IAA should be on a case-by-case basis. However, the relatively high incidence of primary ATZ can