Fate of the Rectal Stump After Subtotal Colectomy for Ulcerative Colitis in the Era of Ileal Pouch–Anal Anastomosis

Munie, Semeret; Hyman, Neil; Osler, Turner M.

doi:10.1001/jamasurg.2013.177

Cited by 42 publications

(43 citation statements)

References 33 publications

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“…Interestingly, more patients undergoing laparoscopic STC had a restorative procedure with IPAA or IRA in comparison to open STC. Again, In addition, like others [41], one-third of our overall population is under active endoscopic surveillance awaiting a second-stage procedure; these results should therefore be interpreted with caution. In the literature, the type of second-stage procedure does not seem to be related to the initial approach [10,32].…”

Section: Discussionsupporting

confidence: 64%

Subtotal colectomy for ulcerative colitis: lessons learned from a tertiary centre

et al. 2017

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Section: Discussionsupporting

confidence: 64%

Subtotal colectomy for ulcerative colitis: lessons learned from a tertiary centre

et al. 2017

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“…The latter group of patients is often older, as documented in this study. The relevance of considering a definitive proctocolectomy is pointed out by the fact that as many as 10-19% of patients initially undergoing total colectomy with ileostomy will not have their rectum removed [2,3] . These patients are reported to have a decreased quality of life [2] , and approximately 50% are bothered by bloody secretion from the rectum requiring continuous medical treatment (often topical).…”

Section: Discussionmentioning

confidence: 99%

“…A majority of patients, who have undergone a total colectomy, will later have a restorative procedure performed. About 20% of the patients will either retain their rectum or undergo a completion proctectomy at a later stage [2][3][4] . Approximately, 50% of pa-…”

Section: Introductionmentioning

confidence: 99%

Safety of Proctocolectomy for Ulcerative Colitis Under Elective and Non-Elective Circumstances: Preoperative Corticosteroid Treatment Worsens Outcome

Balachandran

Tøttrup²

2015

Dig Surg

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Background/Aims: Approximately 20% of patients undergoing surgery for ulcerative colitis will retain their rectum. A single-stage proctocolectomy could be an appropriate procedure in patients who are definitely not candidates for a later restorative procedure, but it is generally not advised in acutely ill patients. The aim was to investigate the safety of one-stage proctocolectomy under elective and non-elective circumstances, with specific reference to identifying possible risk factors for postoperative complications. Methods: A retrospective cohort study, including 54 consecutive patients undergoing proctocolectomy for ulcerative colitis. Out of these, 27 (50%) were admitted non-electively. Results: Postoperative complications were observed in 30 patients (54%). Wound dehiscence, wound infection, and impaired perineal wound healing were observed in 10 (18.5%), 8 (14.8%), and 10 (18.5%) of the patients, respectively. There was no difference between elective and non-elective cases. Complications were observed more often in patients receiving high-dose corticosteroids (18/26 vs. 12/28; p = 0.06). Impaired perineal wound healing and reoperations were observed more often in the corticosteroid-treated group (8/26 vs. 2/28; p = 0.04 and 12/26 vs. 1/28; p = 0.0003). Conclusions: Proctocolectomy is equally safe under elective and non-elective situations, but a preoperative treatment with high-dose corticosteroids is associated with an increased risk of complications and reoperations.

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“…For patients with CD who wish to retain the rectum which has no active inflammation, an IRA is a potential surgical option, provided a clear plan for rectal stump surveillance is discussed and agreed. 103,104…”

Section: Total Abdominal Colectomymentioning

confidence: 99%

Colorectal Cancer in Inflammatory Bowel Disease

Nebbia

Yassin

Spinelli

2020

Clin Colon Rectal Surg

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Patients with inflammatory bowel disease (IBD) are at an increased risk for developing colorectal cancer (CRC). However, the incidence has declined over the past 30 years, which is probably attributed to raise awareness, successful CRC surveillance programs and improved control of mucosal inflammation through chemoprevention. The risk factors for IBD-related CRC include more severe disease (as reflected by the extent of disease and the duration of poorly controlled disease), family history of CRC, pseudo polyps, primary sclerosing cholangitis, and male sex. The molecular pathogenesis of inflammatory epithelium might play a critical role in the development of CRC. IBD-related CRC is characterized by fewer rectal tumors, more synchronous and poorly differentiated tumors compared with sporadic cancers. There is no significant difference in sex distribution, stage at presentation, or survival. Surveillance is vital for the detection and subsequently management of dysplasia. Most guidelines recommend initiation of surveillance colonoscopy at 8 to 10 years after IBD diagnosis, followed by subsequent surveillance of 1 to 2 yearly intervals. Traditionally, surveillance colonoscopies with random colonic biopsies were used. However, recent data suggest that high definition and chromoendoscopy are better methods of surveillance by improving sensitivity to previously “invisible” flat dysplastic lesions. Management of dysplasia, timing of surveillance, chemoprevention, and the surgical approaches are all areas that stimulate various discussions. The aim of this review is to provide an up-to-date focus on CRC in IBD, from laboratory to bedside.

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Fate of the Rectal Stump After Subtotal Colectomy for Ulcerative Colitis in the Era of Ileal Pouch–Anal Anastomosis

Cited by 42 publications

References 33 publications

Subtotal colectomy for ulcerative colitis: lessons learned from a tertiary centre

Subtotal colectomy for ulcerative colitis: lessons learned from a tertiary centre

Safety of Proctocolectomy for Ulcerative Colitis Under Elective and Non-Elective Circumstances: Preoperative Corticosteroid Treatment Worsens Outcome

Colorectal Cancer in Inflammatory Bowel Disease

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