SEGMENTAL COLECTOMY IN ULCERATIVE COLITIS
Sumeyye Yilmaz*, Rebecca L. Gunter, Arielle E. Kanters, David R. Rosen, Jeremy M. Lipman, Stefan D. Holubar, Tracy L. Hull, Scott Steele
Colorectal Surgery, Cleveland Clinic, Cleveland, OH
Background
Restorative proctocolectomy (TPC) with ileal pouch-anal anastomosis (IPAA) is the gold standard surgical treatment of ulcerative colitis (UC), offering complete removal of the diseased colon and effective prevention and treatment of colorectal cancer. Segmental colectomy (SC) is rarely performed, though considered in select patients such as those with quiescent disease, or elderly with comorbidities who are high risk for postoperative morbidity and poor function following IPAA surgery. We aimed to assess postoperative and long-term outcomes of SC in UC
Methods
Retrospective chart review of UC patients who underwent SC at our tertiary care center from 1999 to 2022 was performed. Primary outcomes were postoperative complication, early flare, cancer recurrence, & subsequent total abdominal colectomy (TAC)/TPC rate. Data is presented as mean (standard deviation), median [25-75 percentiles] or frequency (percent)
Results
61 patients [21 (34.4%) female] were identified. Median age at the time of diagnosis and surgery were 41.5 (30-59) and 67.7 (56.8-76.5) years, respectively. Median body mass index was 27.9 (24.6-31.7) kg/m2. 36 (59%) patients had American Society of Anesthesiologists score of III. 53 (86.9%) patients had at least one comorbidity. 51 (83.6%) patients had Mayo score of 0-1 at the time of surgery. Patients underwent: Right hemicolectomy (n=30, 49.2%), left hemicolectomy (n=6, 9.8%), sigmoidectomy (n=19, 31.1%), low anterior resection (n=4, 6.6%), and segmental resection (n=2, 9.8%) for cancer (n=15, 24.6%), dysplasia/polyps (n=21, 34.4%), diverticular disease (n=13, 21.3%), stricture (n=6, 9.8%), fistula (n=3, 4.9%), bleeding (n=1, 1.6%), and megacolon (n=1, 1.6%). The median duration of operation and estimated blood loss were 168.5 (130-210) min and 100 (40-150) ml, respectively. 18 (29.5%) patients had postoperative complications, most commonly ileus (n=7, 11.5%). 7 (11.5%) patients had complications of Clavien-Dindo Class III-V. Median time to start of diet and return of bowel function were 1.5 (1-4) and 3 (2-4) days, respectively. One (1.6%) patient had anastomotic leak, while sepsis occurred in 1 (1.6%) patient. Median length of hospital stay was 5 (3-8.5) days. Early postoperative flare (within 3 months of surgery) occured in 5 (8.2%) patients. Among 36 patients with dysplasia/cancer, 1 had metachronous colon cancer and 1 developed distant recurrence at 19.5 and 23 months after surgery, respectively. 4 (6.6%) patients underwent subsequent TAC/TPC. Median follow-up time was 35.5 (5.5-63.9) months. 2-year and 5-year overall survival rates were 92% and 78.7%, respectively
Conclusion
In selected UC patients, such as elderly patients with comorbidities who have no-minimal disease activity, SC can be a safe and feasible option providing low postoperative complication, early flare, cancer recurrence and need for subsequent TAC/TPC rates
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