C oronavirus disease 2019 (COVID-19) caused a worldwide disruption of regular health care, with more than 37 million cases and over 1,000,000 deaths. 1 After confirmation of the first COVID-19 patient in The Netherlands, a country with 17.4 million inhabitants and universal health care, on February 27, 2020, the pandemic rapidly spread across the country, reaching its first peak in April 2020. 2 Regular health care, including inflammatory bowel disease (IBD) care, was strongly reduced to establish sufficient capacity for COVID-19 care and to prevent COVID-19 spread by patients and healthcare workers.Abbreviations used in this paper: COVID-19, coronavirus disease 2019; CRC, colorectal cancer; IBD, inflammatory bowel disease; PALGA, the nationwide network and registry of histo-and cytopathology in the Netherlands.

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Background: Inflammatory bowel disease (IBD) patients are at increased risk of advanced neoplasia (high-grade dysplasia or colorectal cancer). The authors aimed to (1) assess synchronous and metachronous neoplasia following (sub)total or proctocolectomy, partial colectomy or endoscopic resection for advanced neoplasia in IBD, and (2) identify factors associated with treatment choice. Material and methods: In this retrospective multicenter cohort study, the authors used the Dutch nationwide pathology databank (PALGA) to identify patients diagnosed with IBD and colonic advanced neoplasia (AN) between 1991 and 2020 in seven hospitals in the Netherlands. Logistic and Fine & Gray’s subdistribution hazard models were used to assess adjusted subdistribution hazard ratios for metachronous neoplasia and associations with treatment choice. Results: The authors included 189 patients (high-grade dysplasia n =81; colorectal cancer n =108). Patients were treated with proctocolectomy ( n =33), (sub)total colectomy ( n =45), partial colectomy ( n =56) and endoscopic resection ( n =38). Partial colectomy was more frequently performed in patients with limited disease and older age, with similar patient characteristics between Crohn’s disease and ulcerative colitis. Synchronous neoplasia was found in 43 patients (25.0%; (sub)total or proctocolectomy n =22, partial colectomy n =8, endoscopic resection n =13). The authors found a metachronous neoplasia rate of 6.1, 11.5 and 13.7 per 100 patient-years after (sub)total colectomy, partial colectomy and endoscopic resection, respectively. Endoscopic resection, but not partial colectomy, was associated with an increased metachronous neoplasia risk (adjusted subdistribution hazard ratios 4.16, 95% CI 1.64–10.54, P <0.01) compared with (sub)total colectomy. Conclusion: After confounder adjustment, partial colectomy yielded a similar metachronous neoplasia risk compared to (sub)total colectomy. High metachronous neoplasia rates after endoscopic resection underline the importance of strict subsequent endoscopic surveillance.

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