Hoshino Nobuaki, Hida Koya, Yoshida Shinya, Ueno Kohei, Noguchi Tatsuki, Ishihara Soichiro, Sugihara Kenichi, Ajioka Yoichi, Obama Kazutaka
Department of Surgery Kyoto University Graduate School of Medicine Kyoto Japan.
Department of Surgical Oncology The University of Tokyo Tokyo Japan.
Ann Gastroenterol Surg. 2023 Feb 7;7(4):626-636. doi: 10.1002/ags3.12659. eCollection 2023 Jul.
Patients with ulcerative colitis are reported to be at increased risk of colorectal cancer and are also at high risk of postoperative complications. However, the incidence of postoperative complications in these patients and how the type of surgery performed affects prognosis are not well understood.
Data collected by the Japanese Society for Cancer of the Colon and Rectum on ulcerative colitis patients with colorectal cancer between January 1983 and December 2020 were analyzed according to whether total colorectal resection was performed with ileoanal anastomosis (IAA), ileoanal canal anastomosis (IACA), or permanent stoma creation. The incidence of postoperative complications and the prognosis for each surgical technique were investigated.
The incidence of overall complications was not significantly different among the IAA, IACA, and stoma groups (32.7%, 32.3%, and 37.7%, respectively; = 0.510). The incidence of infectious complications was significantly higher in the stoma group (21.2%) than in the IAA (12.9%) and IACA (14.6%) groups ( = 0.048); however, the noninfectious complication rate was lower in the stoma group (13.7%) than in the IAA (21.1%) and IACA (16.2%) groups ( = 0.088). Five-year relapse-free survival was higher in patients without complications than in those with complications in the IACA group (92.8% vs. 75.2%; = 0.041) and the stoma group (78.1% vs. 71.2%, = 0.333) but not in the IAA group (90.3% vs. 90.0%, = 0.888).
The risks of infectious and noninfectious complications differed according to the type of surgical technique used. Postoperative complications worsened prognosis.
据报道，溃疡性结肠炎患者患结直肠癌的风险增加，术后并发症风险也很高。然而，这些患者术后并发症的发生率以及所行手术类型如何影响预后尚不清楚。
日本结直肠癌学会收集的1983年1月至2020年12月期间患有结直肠癌的溃疡性结肠炎患者的数据，根据是否进行了全结肠直肠切除并回肠肛管吻合术（IAA）、回肠肛管通道吻合术（IACA）或永久性造口术进行分析。研究了每种手术技术的术后并发症发生率和预后。
IAA组、IACA组和造口组的总体并发症发生率无显著差异（分别为32.7%、32.3%和37.7%；P = 0.510）。造口组的感染性并发症发生率（21.2%）显著高于IAA组（12.9%）和IACA组（14.6%）（P = 0.048）；然而，造口组的非感染性并发症发生率（13.7%）低于IAA组（21.1%）和IACA组（16.2%）（P = 0.088）。IACA组无并发症患者的5年无复发生存率高于有并发症患者（92.8%对75.2%；P = 0.041），造口组也如此（78.1%对71.2%，P = 0.333），但IAA组并非如此（90.3%对90.0%，P = 0.888）。
感染性和非感染性并发症的风险因所采用的手术技术类型而异。术后并发症会使预后恶化。
