P403 Colectomy is not a cure for ulcerative colitis: A systematic review
L. Peyrin-Biroulet*1, A.S. Patel2, J.O. Lindsay3
1Nancy University Hospital, Université de Lorraine, Inserm U954 and Department of Gastroenterology, Vandouvre-les-Nancy, France, 2Abacus International, Systematic Review, Bicester, United Kingdom, 3The Royal London Hospital, Barts Health NHS Trust Department of Gastroenterology, London, United Kingdom
Colectomy for ulcerative colitis (UC) is associated with short- and long-term complications. Estimates of the frequency of such complications are highly variable. Understanding the true burden of surgical complications is important to clinicians in assessing the risks and benefits of colectomy versus continued medical therapy. A systematic review was therefore conducted to ascertain the frequency or incidence of surgical complications occurring in patients undergoing selected colorectal procedures for UC.
Embase, MEDLINE and The Cochrane Library were searched for studies published from 2002-2014 reporting the incidence of any of the following surgical complications of colorectal procedures in adults with UC: ileo-anal anastomosis or ileal pouch-anal anastomosis, ileo-anal pouch procedure, restorative proctocolectomy, subtotal colectomy or total colectomy. Included studies were randomised controlled trials (RCTs) and prospective or retrospective non-RCTs. Conference proceedings from January 2011-January 2014 were also searched manually. Quality assessment for risk of bias was conducted for each individual study.
A total of 99 studies (98 non-RCTs and one RCT) enrolling 184,157 patients and reporting outcomes from surgical procedures conducted between 1976 and 2014 were identified. Early complications (occurring ≤ 30 days postoperatively) were reported in 11-44% of patients (32 studies). Late complications (occurring >30 days postoperatively) were reported in 19-55% of patients across studies. The most frequently occurring short-term complications ( ≤ 30 days) were infectious complications (16%) and general pouch-related complications (8%). The most frequent long-term complications (>30 days) were pouchitis (30% of patients), Crohn's disease of the pouch (25% of patients) and infertility (50% of patients).
Approximately one third of patients undergoing surgery for UC are anticipated to experience long-term or later occurring postoperative complications. Colectomy is not a cure for UC, although it remains an appropriate therapeutic strategy for specific groups of patients.