Introduction
Over the past two decades, advancements in medical and surgical therapy have significantly impacted hemorrhagic rectocolitis management. However, it is still not clear what happens in three situations when a colectomy is done during ulcerative colitis (UC): severe acute colitis, an illness that does not get better with medicine, and precancerous lesions.
Aims & Methods
The objective of this study was to evaluate the changes in the reasons and methods for using the UC during the last two decades.This study is an observational retrospective at a university hospital center, examining the progress of operational indicators in patients monitored for colorectal hyperplasia and who underwent segmental or complete colectomy between 2003 and 2023. The primary aim is to compare changes in patient characteristics, compare surgical methods (laparotomy and laparoscopy), and determine the frequencies of early and late post-operative problems based on the Clavien Dindo classification.
Results
The study analyzed 286 patients, with 57% being males and a median age of 40 years. The majority were pancholic and 35% were left-handed. Between 2003 and 2013, 87 patients underwent surgery for refractory chronic colitis (RCH) and 199 patients for severe acute colitis or (pre-)neoplastic lesions. The preoperative clinical features showed similarities between the two groups, particularly in terms of the duration of the course and severity. Over time, there has been a decline in colectomies for refractory chronic colitis, but an increase in colectomies for severe acute colitis or (pre-)neoplastic lesions. The utilization of laparotomy decreased from 52.3% to 18.6%, while the use of laparoscopy increased from 47.7% to 81.4%. An increase in the rate of mechanical ieo-anal anastomosis was detected.
There was no significant difference in the death rate 30 days following colectomy. The incidence of severe early problems following colectomy fell from 12.6% to 5.5%, while the average number of late complications reduced from 1.6 to 0.8. The rate of late recurrence of operation decreased from 38.6% to 19.5%. However, the incidence of infectious complications increased from 27% to 45.7%.
When comparing the two periods, there were notable disparities in the average number of biotherapies received, preoperative exposure to infliximab, and subcutaneous anti-TNFα. The utilization of infliximab considerably increased after 2013 in cases of severe acute colitis.
Conclusion
The study confirms changes in colectomy criteria for chronic ulcerative colitis over the past two decades, with a decrease in treatment-resistant cases and an increase in severe acute colitis or dysplasia/cancer cases, while laparoscopy usage has increased, reducing morbidity despite biotherapies usage.
References
1/ "Long-term outcome of colectomy for severe ulcerative colitis in patients who failed rescue therapy with cyclosporine." Matsuoka K, et al. Alimentary Pharmacology & Therapeutics, 2015.
2/ "Early predictors of severe clinical events in an Italian cohort of patients with ulcerative colitis in a real-world setting." Danese S, et al. Journal of Crohn's and Colitis, 2021.
3/ "British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults." Lamb CA, et al. Gut, 2019.