Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
ANZ J Surg. 2024 Sep;94(9):1598-1609. doi: 10.1111/ans.18986. Epub 2024 Mar 25.
Total (procto)colectomy is indicated in 15%-20% of ulcerative colitis(UC) patients during their disease course. Reconstruction options to avoid a permanent ileostomy include an ileoanal pouch anastomosis (IPAA) or ileorectal anastomosis (IRA). This study aimed to investigate reconstruction rates using Australian-based population-level data, and factors influencing reconstruction.
A retrospective data linkage study of the NSW population over a 19-year period was performed. Patients with UC who underwent total (procto)colectomy with a minimum of 1-year follow up were included. The main outcome was reconstruction with either IPAA or IRA. The influence of hospital and patient factors on reconstruction rates was assessed by Cox regression.
Overall, 1047 patients underwent a (procto)colectomy for UC (mean age 45.9 years [SD ± 18.3], 640 [61.1%] male). The 5-year reconstruction rate was 55% (IPAA 89%). Advanced age, emergent colectomy, higher comorbidity burden, and geographical remoteness were significantly associated with lower reconstruction rates. A lower reconstruction rate was also observed in the most recent time-period (2014-2019) (aHR 0.68[95% CI 0.54-0.86]), and where index (procto)colectomy was performed in low-volume (<1 pouch/year) pouch hospitals (aHR 0.60 [95% CI 0.43-0.82]).
NSW Australia has the highest reported rate of reconstruction following UC (procto)colectomy globally. However, rates reduced in the most recent time-period. There was variation in reconstruction rates across centres, with primary and overall reconstruction rates proportionate to hospital pouch volume. Reconstruction rates were also lower for patients living outside major cities. To ensure equitable opportunities for reconstruction, patients being considered for IBD pouch surgery should be centralized to a limited number of specialist pouch centres.
在溃疡性结肠炎（UC）患者的病程中，有 15%-20%需要进行全（直肠）结肠切除术。避免永久性回肠造口的重建选择包括回肠肛管吻合术（IPAA）或回肠直肠吻合术（IRA）。本研究旨在使用基于澳大利亚的人群水平数据调查重建率，并探讨影响重建的因素。
对过去 19 年新南威尔士州人群进行了一项回顾性数据链接研究。纳入接受全（直肠）结肠切除术且至少有 1 年随访的 UC 患者。主要结局是采用 IPAA 或 IRA 进行重建。采用 Cox 回归评估医院和患者因素对重建率的影响。
共有 1047 例 UC 患者接受了（直肠）结肠切除术（平均年龄 45.9 岁[标准差 ± 18.3]，640 例[61.1%]为男性）。5 年重建率为 55%（IPAA 为 89%）。高龄、急诊手术、更高的合并症负担和地理位置偏远与较低的重建率显著相关。最近的时间段（2014-2019 年）的重建率也较低（aHR 0.68[95%CI 0.54-0.86]），并且索引（直肠）结肠切除术在低容量（<1 个袋/年）袋状医院进行（aHR 0.60 [95%CI 0.43-0.82]）。
澳大利亚新南威尔士州的 UC（直肠）结肠切除术后重建率居全球最高。然而，最近的重建率有所下降。不同中心的重建率存在差异，主要和总体重建率与医院袋状手术量成比例。居住在主要城市以外的患者的重建率也较低。为了确保重建机会公平，考虑接受 IBD 袋状手术的患者应集中到少数几个专业袋状中心。
