Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
, Hamilton, Canada.
J Gastrointest Surg. 2021 Oct;25(10):2610-2618. doi: 10.1007/s11605-021-04913-6. Epub 2021 Feb 8.
The extent of surgical resection in inflammatory bowel disease (IBD) patients who develop colorectal cancer (CRC) is not prescribed by guidelines. We aim to evaluate, at a population level, the association of extent of surgical resection with survival outcomes.
Using a validated Ontario registry of Crohn's disease (CD) and ulcerative colitis (UC) patients, we identified patients who underwent colorectal cancer resection between 2007 and 2015. Patient, tumor, and treatment factors, including type of surgical resection, were collected. Resections were grouped as segmental, total colectomy, and proctocolectomy. Multivariable cox proportional hazard regression was performed to identify factors associated with survival, including extent of surgical resection.
Between 2007 and 2015, 84,694 patients had resections for CRC in the province of Ontario, 599 had ulcerative colitis (UC), and 366 had Crohn's disease (CD). Segmental resection was the most common operation performed and was more common in CD patients compared to UC (68% vs. 45.6%, p < 0.001). Five-year survival was 63.7% (95% CI 59.5-67.7) in UC patients and 57.5% (95% CI 51.9-62.7) in CD patients (p = 0.033). Multivariable analysis showed worse survival in patients undergoing total colectomy, compared to segmental resection [HR 1.70 (95% CI 1.31-2.21), p < 0.001]. There was no significant difference in survival between patients undergoing segmental resection and proctocolectomy [HR 0.99 (95% CI 0.78-1.27)]. This pattern was similar within the subtypes of IBD.
In the setting of IBD-associated CRC, segmental resection and proctocolectomy are associated with similar survival outcomes in both UC and CD patients. Prospective study is essential to explore these findings.
炎性肠病（IBD）患者发生结直肠癌（CRC）时的手术切除范围并未在指南中规定。我们旨在从人群水平评估手术切除范围与生存结果的相关性。
我们使用经过验证的安大略省克罗恩病（CD）和溃疡性结肠炎（UC）患者登记处，确定了 2007 年至 2015 年间接受结直肠癌切除术的患者。收集了患者、肿瘤和治疗因素，包括手术切除类型。将切除术分为节段性、全结肠切除术和直肠结肠切除术。采用多变量 Cox 比例风险回归分析确定与生存相关的因素，包括手术切除范围。
2007 年至 2015 年间，安大略省有 84694 例患者因 CRC 接受了切除术，其中 599 例为溃疡性结肠炎（UC），366 例为克罗恩病（CD）。节段性切除术是最常见的手术，且在 CD 患者中比 UC 患者更常见（68% vs. 45.6%，p<0.001）。UC 患者的 5 年生存率为 63.7%（95%CI 59.5-67.7），CD 患者为 57.5%（95%CI 51.9-62.7）（p=0.033）。多变量分析显示，与节段性切除术相比，全结肠切除术患者的生存状况更差[HR 1.70（95%CI 1.31-2.21），p<0.001]。节段性切除术与直肠结肠切除术患者的生存差异无统计学意义[HR 0.99（95%CI 0.78-1.27）]。在 IBD 相关 CRC 中，这种模式在 UC 和 CD 患者中均适用。需要前瞻性研究来探索这些发现。
