Segmental colectomy for ulcerative colitis: is there a place in selected patients without active colitis ? An international multicentric retrospective study in 72 patients
Résumé
BACKGROUND AND AIMS
The aim of this study was to report a multicentric experience of segmental colectomy (SC) in ulcerative colitis (UC) patients without active colitis in order to assess if SC can represent or not an alternative to ileal pouch-anal anastomosis (IPAA). METHODS:All UC patients undergoing SC were included. Postoperative complications according to Clavien-Dindo's classification, long- term results and risk factors for postoperative colitis and reoperation for colitis on the remnant colon were assessed. RESULTS:72 UC patients underwent: sigmoidectomy (n=28), right colectomy (n=24), proctectomy (n=11) or left colectomy (n=9) for colonic cancer (n=27), "diverticulitis" (n=17), colonic stenosis (n=5), dysplasia or polyps (n=8), and miscellaneous (n=15). Three patients died postoperatively and 5/69 patients (7%) developed early flare of UC within 3 months after SC. After a median follow-up of 40 months, 24/69 patients (35%) were reoperated after a median delay after SC of 19 months (range, 2-158): 22/24 (92%) underwent total colectomy and ileorectal anastomosis (n=9) or TCP (n=13) and 2/24 (8%) an additional SC. Reasons for reoperation were: colitis (n=14; 20%), cancer (n=3) or dysplasia (n=3), colonic stenosis (n=1), and unknown reason (n=3). Endoscopic score of colitis before SC was Mayo 2-3 in 5/5 (100%) patients with early flare vs 15/42 without (36%; p=0.0101) and in 9/12 (75%) patients with reoperation for colitis vs 11/35 without (31%; p=0.016).
CONCLUSIONS
After segmental colectomy in UC patients, postoperative early colitis is rare (7%). Segmental colectomy could possibly represent an alternative to IPAA in selected UC patients without active colitis.