The Risk of Colectomy and Colorectal Cancer After Appendectomy in Patients With Ulcerative Colitis: A Systematic Review and Meta-analysis

Stellingwerf, M E; Koning, Marlou A. de; Pinkney, Thomas; Bemelman, Willem A.; D’Haens, Geert R.; Buskens, Christianne J.

doi:10.1093/ecco-jcc/jjy163

Cited by 29 publications

(21 citation statements)

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“…By altering metabolite levels and impairing host immune responses, persistent dysbiosis can promote the development of various diseases such as inflammatory bowel disease, celiac disease, cardiovascular disease, DM, rheumatoid arthritis, osteoarthritis, and even neurologic disorders via the brain-gut axis [20][21][22][23][24][25][26][27] . A significant association between appendectomy and these diseases has been observed in some large cohort studies [28][29][30][31][32][33][34] . www.nature.com/scientificreports/ Dysbiosis has also been linked to lung, breast, and GI cancers [5][6][7][8][12][13][14] .…”

Section: Discussionmentioning

confidence: 79%

“…Second, irritable bowel disease and pre-existing adenomas were not taken into account in the risk analysis. Considering the fact that irritable bowel disease might be suppressed by appendectomy and colonic adenomas are premalignant lesions, they are potential hidden confounding factors 28 , 29 . Third, the follow-up period in our study was shorter than the conventional follow-up period of 10 years, which is based on the time frame (7–10 years on average) of the adenoma to carcinoma transition 15 , 41 , 42 .…”

Section: Discussionmentioning

confidence: 99%

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A link between appendectomy and gastrointestinal cancers: a large-scale population-based cohort study in Korea

Park

Lee

et al. 2020

Sci Rep

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An association between appendectomy and subsequent gastrointestinal (GI) cancer development has been postulated, although the evidence is limited and inconsistent. To provide clarification, we investigated the link between appendectomy and GI cancers in a large nationwide appendectomy cohort. This cohort was derived from the claims database of the National Health Insurance Service in South Korea and comprised 158,101 patients who had undergone appendectomy between 2007 and 2014. A comparison cohort of 474,303 subjects without appendectomy was selected after 1:3 matching by age and sex. The incidence of GI cancers after appendectomy was observed, and risk factors for GI cancers were determined by using a multivariable-adjusted proportional hazards model. Appendectomy did not significantly increase the incidence of GI cancers in the overall population (1.529 and 1557 per 1000 person-years in the non-appendectomy and appendectomy cohorts, respectively). However, appendectomy significantly increased the incidence of GI cancers in subgroups consisting of elderly (≥ 60 years) patients (adjusted HR, 1.102; 95% confidence interval, 1.011–1.201; p = 0.028) or women (adjusted HR, 1.180; 95% confidence interval, 1.066–1.306; p = 0.001).

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

A link between appendectomy and gastrointestinal cancers: a large-scale population-based cohort study in Korea

Park

Lee

et al. 2020

Sci Rep

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“…It is concerning that some studies have suggested there may be an increased risk of high‐grade dysplasia and colorectal cancer in patients with ulcerative colitis who have undergone appendicectomy. However, a recent systematic review and meta‐analysis suggested that this may be due to colectomy being postponed owing to the positive effect of appendicectomy on disease activity. This highlights the need for close surveillance after appendicectomy, because ongoing (subclinical) inflammation increases the risk of colorectal cancer.…”

Section: Discussionmentioning

confidence: 99%

Prospective cohort study of appendicectomy for treatment of therapy-refractory ulcerative colitis

Stellingwerf

Sahami

Winter

et al. 2019

British Journal of Surgery

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Introduction: Appendicectomy may reduce relapses and need for medication in patients with ulcerative colitis, but long-term prospective data are lacking. This study aimed to analyse the effect of appendicectomy in patients with refractory ulcerative colitis.Methods: In this prospective multicentre cohort series, all consecutive patients with refractory ulcerative colitis referred for proctocolectomy between November 2012 and June 2015 were counselled to undergo laparoscopic appendicectomy instead. The primary endpoint was clinical response (reduction of at least 3 points in the partial Mayo score) at 12 months and long-term follow-up. Secondary endpoints included endoscopic remission (endoscopic Mayo score of 1 or less), failure (colectomy or start of experimental medication), and changes in Inflammatory Bowel Disease Questionnaire (IBDQ) (range 32-224), EQ-5D™ and EORTC-QLQ-C30-QL scores.Results: A total of 28 patients (13 women; median age 40⋅5 years) underwent appendicectomy. The mean baseline IBDQ score was 127⋅0, the EQ-5D™ score was 0⋅65, and the EORTC-QLQ-C30-QL score was 41⋅1. At 12 months, 13 patients had a clinical response, five were in endoscopic remission, and nine required a colectomy (6 patients) or started new experimental medical therapy (3). IBDQ, EQ-5D™ and EORTC-QLQ-C30-QL scores improved to 167⋅1 (P < 0⋅001), 0⋅80 (P = 0⋅003) and 61⋅0 (P < 0⋅001) respectively. After a median of 3⋅7 (range 2⋅3-5⋅2) years, a further four patients required a colectomy (2) or new experimental medical therapy (2). Thirteen patients had a clinical response and seven were in endoscopic remission. The improvement in IBDQ, EQ-5D™ and the EORTC-QLQ-C30-QL scores remained stable over time.Conclusion: Appendicectomy resulted in a clinical response in nearly half of patients with refractory ulcerative colitis and a substantial proportion were in endoscopic remission. Elective appendicectomy should be considered before proctocolectomy in patients with therapy-refractory ulcerative colitis.

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“…These results are not in agreement with previous studies. A meta‐analysis that investigated the colectomy rate in 10 studies, including 72 423 UC patients in total, did not find significant differences between patients with and without appendectomy (OR 1.25) [12]. These studies included colectomies indicated for active UC as well as colorectal neoplasia, and a shift was seen after appendectomy with fewer colectomies required for refractory colitis but more for colorectal neoplasia.…”

Section: Discussionmentioning

confidence: 99%

“…However, at the same time, studies are emerging that demonstrate an increased colectomy rate, and remarkably an increased colorectal cancer (CRC) rate, after appendectomy in UC [10,11]. A recent systematic review and meta-analysis investigated these possible correlations in UC [12]. In this meta-analysis, the authors attempted to correct for possible confounding factors for developing CRC, including duration of UC disease, extent and severity of the disease, primary sclerosing cholangitis (PSC) and a family history for CRC [13].…”

Section: Introductionmentioning

confidence: 99%

A nationwide database study on colectomy and colorectal cancer in ulcerative colitis: what is the role of appendectomy?

et al. 2020

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Aim Although has been suggested that an appendectomy has a positive effect on the disease course in patients with ulcerative colitis (UC), recent studies indicate a potential increase in risk of colectomy and colorectal cancer (CRC). This study aimed to evaluate the rates of colectomy and CRC after appendectomy in UC patients using a nationwide prospective database [the Initiative on Crohn and Colitis Parelsnoer Institute – Inflammatory Bowel Disease (ICC PSI‐IBD) database]. Method All UC patients were retrieved from the ICC PSI‐IBD database between January 2007 and May 2018. Primary outcomes were colectomy and CRC. Outcomes were compared in patients with and without appendectomy, with a separate analysis for timing of appendectomy (before or after UC diagnosis). Results A total of 826 UC patients (54.7% female; median age 46 years, range 18–89 years) were included. Sixty‐three (7.6%) patients had previously undergone appendectomy: 24 (38.1%) before and 33 (52.4%) after their diagnosis of UC. In multivariate analysis, appendectomy after UC diagnosis was associated with a significantly lower colectomy rate compared with no appendectomy [hazard ratio (HR) 0.16, 95% C: 0.04–0.66, P = 0.011], and the same nonsignificant trend was seen in patients with an appendectomy before UC diagnosis (HR 0.35, 95% CI 0.08–1.41, P = 0.138). Appendectomy was associated with delayed colectomy, particularly when it was performed after diagnosis of UC (P = 0.009). No significant differences were found in the CRC rate between patients with and without appendectomy (1.6% vs 1.2%; P = 0.555). Conclusion Appendectomy in established UC is associated with an 84% decreased risk of colectomy and a delay in surgery. Since the colon is in situ for longer, the risk of developing CRC remains, which underscores the importance of endoscopic surveillance programmes.

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The Risk of Colectomy and Colorectal Cancer After Appendectomy in Patients With Ulcerative Colitis: A Systematic Review and Meta-analysis

Cited by 29 publications

References 29 publications

A link between appendectomy and gastrointestinal cancers: a large-scale population-based cohort study in Korea

A link between appendectomy and gastrointestinal cancers: a large-scale population-based cohort study in Korea

Prospective cohort study of appendicectomy for treatment of therapy-refractory ulcerative colitis

A nationwide database study on colectomy and colorectal cancer in ulcerative colitis: what is the role of appendectomy?

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