Practice Parameters for the Surgical Treatment of Ulcerative Colitis

Ross, Howard M.; Steele, Scott R.; Varma, Mika; Dykes, Sharon L.; Cima, Robert R.; Buie, W. Donald; Rafferty, Janice F.

doi:10.1097/dcr.0000000000000030

Cited by 159 publications

(104 citation statements)

References 266 publications

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“…A Cox model in a group of more than 3200 UC patients showed a cumulative incidence of ATZ/pouch cancer at 5, 10, 15, 20, and 25 years of 0.2, 0.4, 0.8, 2.4, and 3.4 %, respectively [28]. The pouch cancer rate in FAP although low is believed to be slightly higher than that in UC [29]. However, the reliability of current data is limited by the lack of standardization of pouch surveillance and variable definitions of pouch cancer, as well as the growing number of IPAAs being performed.…”

Section: Discussionmentioning

confidence: 99%

Adenocarcinoma of the ileal pouch mucosa: case report and literature review

O’Mahoney

Scherl

Lee

et al. 2014

Int J Colorectal Dis

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The risk of developing ileal pouch mucosa adenocarcinoma appears low. However, increasing reports of these cancers are concerning as most patients present with advanced disease after many years. Patients with a previous history of dysplasia/cancer may be at increased risk. We believe surveillance after IPAA should include the anal transition zone and the ileal pouch mucosa. The establishment of expert consensus guidelines on pouch surveillance should be considered in the near future.

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Section: Discussionmentioning

confidence: 99%

Adenocarcinoma of the ileal pouch mucosa: case report and literature review

O’Mahoney

Scherl

Lee

et al. 2014

Int J Colorectal Dis

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“…Its incidence varies between 5 and 25% after IPAA, [1][2][3][4] negatively affecting health-related quality of life (HRQoL) 4 and being responsible for failure in approximately 50% of cases. In our study, pelvic sepsis was the most common indication for pouch salvage surgery.…”

Section: Septic Complicationsmentioning

confidence: 99%

“…1,2 In experienced hands IPAA achieves excellent functional results. 2 Ileal pouch-anal anastomosis surgery is complex and has welldescribed complications, 1 which may be responsible for pouch malfunctions. Indications for pouch salvage may influence outcome.…”

Section: Introductionmentioning

confidence: 97%

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Outcomes of Salvage Surgery for Ileal Pouch Complications and Dysfunctions. The Experience of a Referral Centre and Review of Literature

Pellino¹,

Selvaggi²

2015

ECCOJC

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Background and Aims: Failure rates of restorative proctocolectomy with ileo pouch-anal anastomosis (IPAA) range between 3.5 and 15%. Salvage surgery aims to preserve the pouch and transanal evacuation. We report our experience with salvage, review the outcomes of revisional pouch surgery, and propose a classification of pouch dysfunction. Methods: We collected data on patients undergoing pouch salvage surgery between 1987 and 2014 at our hospital. Pre-and post-salvage functional data were assessed. Function at the 3-year follow-up was compared with that of matched IPAA controls (study patients:controls, 1:3). Results: Considering only patients who underwent primary IPAA at our centre (n = 31), 5-year failure was higher after salvage compared with primary IPAA (28.8 vs 5.7% log rank test, p = 0.005). Overall, we included 39 patients, with eight additional patients who received primary IPAA elsewhere, undergoing 46 procedures. Most patients had a J-pouch (74.4%) and needed salvage for septic complications. A transperineal approach was used in 22 patients, whereas 17 underwent abdominal salvage, with 77.3 and 64.7% success rates, respectively. Minor surgery was effective but required repeated procedures. Overall failure was 28.2% at a median follow-up of 42 (1-153) months. A significant decrease in bowel frequency (p = 0.021) and rate of urgency (p = 0.009) was observed at the 3-year follow-up after salvage in 25 patients available for comparison. Functional results after major salvage procedures were poorer compared with healthy IPAA controls (p = 0.003). Conclusions: Salvage surgery is effective and safe in experienced teams, but the 5-year failure rate is higher after salvage than after successful primary pouch surgery. Sepsis brings about a higher risk of failure compared with mechanical causes of dysfunction.

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“…As stated in 2014 by the Standards Practice Task Force of the American Society of Colon and Rectal Surgeons, 10 chronologic age per se should not be considered an exclusion criterion for IPAA. However, further research is needed to investigate which patients are the best candidates for IPAA on the basis of a careful evaluation of both patient comorbidities and preoperative anorectal function, rather than considering age per se a contraindication.…”

mentioning

confidence: 99%

Restorative proctocolectomy in IBD: does it fit elderly patients too?

Spinelli

Allaix

2017

ECCOJC

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Total proctocolectomy with ileal pouch-anal anastomosis [IPAA] is considered the standard care for the surgical treatment of patients with ulcerative colitis [UC]. 1 The current evidence shows that IPAA is a safe procedure associated with very low postoperative mortality rates, good to excellent long-term functional outcomes, and improvement in quality of life in the vast majority of patients. 2 However, most studies have included only patients younger than 60 years undergoing IPAA by an open approach. Therefore, the outcomes of IPAA in elderly patients are unclear and the potential benefits of the laparoscopic approach in this population are not well understood.Colombo et al. 3 have recently performed a retrospective analysis of the International Pouch Database [IPD] to evaluate safety, efficacy, and long-term outcomes of IPAA in patients who were 65 years old or more. They compared 77 UC patients who were ≥ 65 years old with a control group of 154 younger consecutive unselected UC patients. Overall postoperative complication rates were similar. However, the rates of grades 2, 4, and 5 complications according to Clavien-Dindo classification were significantly higher among the elderly patients, whereas more grade 3 complications were observed after IPAA in younger patients. As a consequence, the hospital stay was significantly longer in elderly patients. Re-operation and 30-day readmission rates were similar in the two groups. Long-term complications, including pouchitis and pouch failure, did not differ between younger and elderly patients. However, the surgical treatment of the pouch failure was tailored: re-do pouch was performed only in younger patients, whereas a permanent defunctioning stoma was created in all cases that occurred in elderly patients. The authors concluded that IPAA is safe even in elderly UC patients and is associated with long-term outcomes similar to those achieved in younger patients.This study is extremely important, challenging one of the major arguments against both restorative proctocolectomy and laparoscopy. The interpretation of these very interesting data is however limited by the lack of quality of life analysis and objective assessment of the anorectal function by functional tests. The results of studies specifically assessing the influence of age on long-term functional outcomes after IPAA are controversial. Delaney 4 et al. in a prospective evaluation of 1895 patients undergoing IPAA, found that incontinence and night-time seepage are more common in patients older than 65 years. On the contrary, Takao et al. 5 in a prospective analysis of 122 patients divided into three groups according to their age [> 60 years, 40-60 years, or < 40 years] found no significant differences between groups in terms of frequency of bowel movements and incontinence scores at 1 or more years of follow-up. Similar results were reported by Kiran et al. 6 who showed in a retrospective analysis of 396 patients with at least 15 years of follow-up, that deterioration of the pouch function after IPAA was...

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Practice Parameters for the Surgical Treatment of Ulcerative Colitis

Cited by 159 publications

References 266 publications

Adenocarcinoma of the ileal pouch mucosa: case report and literature review

Adenocarcinoma of the ileal pouch mucosa: case report and literature review

Outcomes of Salvage Surgery for Ileal Pouch Complications and Dysfunctions. The Experience of a Referral Centre and Review of Literature

Restorative proctocolectomy in IBD: does it fit elderly patients too?

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