Stephens Ian J B, Murphy Brenda, McCawley Niamh, McNamara Deborah A, Burke John P
Department of Colorectal Surgery, Beaumont Hospital, Dublin 9, Ireland.
Royal College of Surgeons Ireland, 123 St. Stephens Green, Dublin, Ireland.
Int J Colorectal Dis. 2025 Jan 14;40(1):12. doi: 10.1007/s00384-024-04779-5.
Proctectomy is frequently deferred at index colectomy for ulcerative colitis due to acuity or immunosuppressive treatments. The retained rectum remains symptomatic in over 50% with associated cancer risk. Management options include index or delayed proctectomy with or without restoration of continuity or surveillance. Comparative studies of perioperative outcomes and reasons for retaining the rectum are lacking.
This 13-year retrospective cohort assesses the fate of the rectum in 168 ulcerative colitis patients by analysing index proctectomy, staged proctectomy and retained rectal remnant determinants and outcomes. The primary outcome was the fate of the rectum. Secondary analysis included perioperative morbidity, length of stay and decision-making determinants.
Proctectomy was performed in 69% of patients, with 16.1% at index surgery. Restorative surgery rate was 44%. Index proctectomy patients were older (54 vs 37 years, p < 0.01), more co-morbid (59.3% vs 38.2%, p = 0.04) and likely to have elective surgery (81.5% vs 21.3%, p < 0.01) or neoplasia (33.3% vs 1.1%, p < 0.01). Outcomes after staged proctectomy were comparable, with age influencing restoration of continuity (33.5 vs 46 years, p < 0.01). Younger patients were indecisive on proctectomy, while those opting for endoscopic surveillance were older (median 65 years, p < 0.01), had more complications (64.3%, p = 0.23) and prolonged hospitalisation (median 15 days, p = 0.02) at colectomy.
Index proctocolectomy for ulcerative colitis is infrequently performed. Perioperative outcomes of restorative and non-restorative staged proctectomy are comparable. Perioperative experience at colectomy may influence patient decisions regarding future management of their rectum.
由于病情严重程度或免疫抑制治疗，溃疡性结肠炎患者在初次结肠切除术时常常推迟行直肠切除术。超过50%保留直肠的患者仍有症状，且存在相关癌症风险。治疗选择包括初次或延迟直肠切除术，可选择或不选择恢复肠道连续性或进行监测。目前缺乏关于围手术期结局以及保留直肠原因的比较研究。
这项为期13年的回顾性队列研究，通过分析初次直肠切除术、分期直肠切除术以及保留直肠残端的决定因素和结局，评估了168例溃疡性结肠炎患者直肠的转归情况。主要结局是直肠的转归。次要分析包括围手术期发病率、住院时间和决策决定因素。
69%的患者接受了直肠切除术，其中16.1%在初次手术时进行。恢复性手术率为44%。初次直肠切除术的患者年龄较大（54岁对37岁，p<0.01），合并症更多（59.3%对38.2%，p=0.04），且更可能接受择期手术（81.5%对21.3%，p<0.01）或患有肿瘤（33.3%对1.1%，p<0.01）。分期直肠切除术后的结局相似，年龄影响肠道连续性的恢复（33.5岁对46岁，p<0.01）。较年轻的患者对直肠切除术犹豫不决，而选择内镜监测的患者年龄较大（中位年龄65岁，p<0.01），结肠切除术后并发症更多（64.3%，p=0.23），住院时间更长（中位15天，p=0.02）。
溃疡性结肠炎患者很少进行初次直肠结肠切除术。恢复性和非恢复性分期直肠切除术的围手术期结局相似。结肠切除术的围手术期经历可能会影响患者对直肠未来治疗的决策。
