The outcome of patients with ulcerative colitis managed by subtotal colectomy.

A total of 1,494 patients with a diagnosis of ulcerative colitis were managed by one surgeon between 1950 and 1981. Subtotal colectomy was performed upon 286 patients of whom 82 had a primary and 65 a secondary ileorectal anastomosis. There was no significant difference in the postoperative mortalities between patients treated by subtotal colectomy (8.7 per cent) and a group of 71 patients treated by proctocolectomy (9.9 per cent). The postoperative mortality after primary and secondary ileorectal anastomosis was 6.9 and 1.5 per cent, respectively. Rectal excision because of disease activity was required in 109 patients after subtotal colectomy (13 after primary and nine after secondary ileorectal anastomosis) with a postoperative mortality of 0.5 per cent. The probability of rectal excision was 21 per cent at 12.6 years after primary anastomosis and 19 per cent at 16.2 years after secondary ileorectal anastomosis. Carcinoma of the rectum has developed in 11 (3.8 per cent) of the patients after subtotal colectomy. The probability of having carcinoma of the rectum develop was 17.1 per cent at 27 years after primary anastomosis and 20.0 per cent at 24 years after secondary ileorectal anastomoiss, the time beyond which no disease has yet been diagnosed in either group. The disease was advanced in stage and of high histologic grade with a median cancer specific survival time of 14 months.