Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
Division of Colon and Rectal Surgery, Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Suite G317, Montreal, H3T 1E2, Quebec, Canada.
J Gastrointest Surg. 2020 Aug;24(8):1721-1728. doi: 10.1007/s11605-020-04666-8. Epub 2020 Jun 15.
Rates of colectomy for ulcerative colitis have been decreasing, particularly since the advent of biologics, but the subsequent impact of reduced colectomy rates on the development of neoplasms in chronically treated ulcerative colitis colons is unknown.
To determine trends in colectomy for colorectal neoplasms in adult patients with ulcerative colitis.
Adult admissions with ulcerative colitis were identified from the National Inpatient Sample from 1993 to 2015. The rate of colectomy with concurrent colorectal neoplasm served as the primary outcome and was evaluated using time trend linear and multivariable regression.
There were 366,286 admissions with ulcerative colitis including 16,556 (4.5%) total colectomies. Of those undergoing colectomy, 2018 (12.2%) had a concurrent diagnosis of colorectal neoplasm. The proportion of colectomies for ulcerative colitis with concurrent colorectal neoplasm increased from 10.3 to 12.5% (p = 0.004). Specifically, the proportion of colectomies performed for dysplasia/benign neoplasm and rectal cancer increased from 3.5 to 5.6% (p < 0.001) and from 2.6 to 3.0% (p = 0.028) respectively, and those for colon cancer remained stable (4.5 to 3.9%, p = 0.423). On multivariate regression, year of colectomy was a significant predictor of colectomy for colorectal neoplasm (OR = 1.044, 95% CI = 1.025-1.062).
Operative management of ulcerative colitis appears to be slowly increasing in oncological indications. The rising proportions of colectomies performed for colorectal neoplasms suggest the need for continued screening in these patients, including rectal surveillance.
溃疡性结肠炎的结肠切除术率一直在下降，尤其是在生物制剂问世之后，但减少结肠切除术率对慢性治疗溃疡性结肠炎结肠中肿瘤发展的后续影响尚不清楚。
确定成人溃疡性结肠炎患者结肠切除术治疗结直肠肿瘤的趋势。
从 1993 年至 2015 年，从国家住院患者样本中确定溃疡性结肠炎成人住院患者。作为主要结局，使用时间趋势线性和多变量回归评估同时患有结直肠肿瘤的结肠切除术率。
有 366286 例溃疡性结肠炎住院患者，其中 16556 例（4.5%）行全结肠切除术。在接受结肠切除术的患者中，有 2018 例（12.2%）同时诊断为结直肠肿瘤。溃疡性结肠炎合并结直肠肿瘤的结肠切除术比例从 10.3%增加到 12.5%（p=0.004）。具体来说，为发育不良/良性肿瘤和直肠癌进行的结肠切除术的比例从 3.5%增加到 5.6%（p<0.001）和从 2.6%增加到 3.0%（p=0.028），而结肠癌的结肠切除术比例保持稳定（4.5%至 3.9%，p=0.423）。在多变量回归中，结肠切除术的年份是结肠切除术治疗结直肠肿瘤的显著预测因素（OR=1.044，95%CI=1.025-1.062）。
溃疡性结肠炎的手术治疗似乎在肿瘤学指征方面逐渐增加。为结直肠肿瘤进行的结肠切除术比例不断上升，这表明需要对这些患者进行持续筛查，包括直肠监测。
