Segmental colectomy versus total proctocolectomy for ulcerative colitis: A systematic review and meta-analysis

IF 2.9 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Colorectal Disease Pub Date : 2025-01-12 DOI:10.1111/codi.17278

Eddy P. Lincango, Oscar Hernandez Dominguez, Tara M. Connelly, Lucas F. Sobrado, Himani Sancheti, David Liska, Jeremy Lipman, Hermann Kessler, Anuradha Bhama, Arielle E. Kanters, Michael Valente, Tracy Hull, Stefan D. Holubar, Scott R. Steele

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Abstract

Aim

Total proctocolectomy (TPC) is the standard of care for patients with ulcerative colitis (UC) and dysplasia not amenable to endoscopic management. However, the risks of an extensive resection may outweigh the benefits in high-risk surgical patients. Therefore, we performed a systematic review and meta-analysis to assess postoperative outcomes between segmental colectomy (SEG) versus TPC in patients with UC.

Study design

Global databases were searched from inception until August 2022 for comparative studies reporting the postoperative outcomes of patients with UC undergoing SEG versus TPC. The primary outcomes were subsequent neoplasia development and overall survival. Odds ratios (ORs), hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs) were calculated. The Newcastle–Ottawa Scale and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) were used for quality-of-evidence assessment.

Results

Eight retrospective studies comprising 4856 patients were included. Overall, 1620 (33%) patients underwent SEG. SEG patients were older, had more comorbidities and mostly underwent right colectomy (40%) and sigmoidectomy (16%). Most studies included UC patients and concomitant colorectal cancer. Reoperation and Clavien–Dindo III–IV odds were equivalent (OR 3.17; 95% CI 0.12, 81.25; I² 66%; OR 0.79; 95% CI 0.48, 1.31; I² 74%). There was no difference in neoplasia development (OR 5.05, 95% CI 0.37, 68.66; I² 61%) nor in overall survival (HR 1.20, 95% CI 0.73, 1.97; I² 61%). The risk of bias was high in all included studies and the quality of evidence was low.

Conclusion

Low-quality evidence failed to demonstrate any discernible differences in the postoperative outcomes between SEG and TPC. However, given the limited granularity of the analysed data and the high likelihood of imprecise results, we cannot assert that SEG and TPC are equivalent. Furthermore, there was a suggestion of an elevated risk of neoplasia development and inferior overall survival in the SEG group.

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溃疡性结肠炎的节段结肠切除术与全直结肠切除术：一项系统回顾和荟萃分析。

目的：全直结肠切除术（TPC）是治疗溃疡性结肠炎（UC）和不典型增生患者的标准治疗方法。然而，在高风险手术患者中，广泛切除的风险可能大于收益。因此，我们进行了系统回顾和荟萃分析，以评估UC患者的节段性结肠切除术（SEG）与TPC的术后结果。研究设计：从建立到2022年8月检索全球数据库，以比较报告UC患者接受SEG和TPC术后结果的研究。主要结局是随后的肿瘤发展和总生存期。计算优势比（ORs）、风险比（hr）及其相应的95%置信区间（ci）。纽卡斯尔-渥太华量表和建议评估、发展和评价分级（GRADE）用于证据质量评估。结果：纳入8项回顾性研究，共4856例患者。总的来说，1620例（33%）患者接受了SEG。SEG患者年龄较大，合并症较多，多数行右结肠切除术（40%）和乙状结肠切除术（16%）。大多数研究包括UC患者和合并结直肠癌。再手术和Clavien-Dindo III-IV的几率相当(OR 3.17；95% ci 0.12, 81.25；I2 66%;或0.79;95% ci 0.48, 1.31；I2 74%)。两组在肿瘤发展方面无差异(OR 5.05, 95% CI 0.37, 68.66；I2 61%)和总生存率(HR 1.20, 95% CI 0.73, 1.97；I2 61%)。所有纳入的研究偏倚风险较高，证据质量较低。结论：低质量的证据未能证明SEG和TPC在术后结果上有任何明显的差异。然而，考虑到分析数据的有限粒度和不精确结果的高可能性，我们不能断言SEG和TPC是等效的。此外，SEG组肿瘤发展的风险增加，总生存期较低。

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来源期刊

Colorectal Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

11.80%

发文量

406

审稿时长

1.5 months

期刊介绍： Diseases of the colon and rectum are common and offer a number of exciting challenges. Clinical, diagnostic and basic science research is expanding rapidly. There is increasing demand from purchasers of health care and patients for clinicians to keep abreast of the latest research and developments, and to translate these into routine practice. Technological advances in diagnosis, surgical technique, new pharmaceuticals, molecular genetics and other basic sciences have transformed many aspects of how these diseases are managed. Such progress will accelerate. Colorectal Disease offers a real benefit to subscribers and authors. It is first and foremost a vehicle for publishing original research relating to the demanding, rapidly expanding field of colorectal diseases. Essential for surgeons, pathologists, oncologists, gastroenterologists and health professionals caring for patients with a disease of the lower GI tract, Colorectal Disease furthers education and inter-professional development by including regular review articles and discussions of current controversies. Note that the journal does not usually accept paediatric surgical papers.