炎症性肠病结肠切除术后直肠癌的发病率:全国性研究。

IF 3.5 3区 医学 Q1 SURGERY BJS Open Pub Date : 2024-09-03 DOI:10.1093/bjsopen/zrae074
Mohammed Deputy, Guy Worley, Elaine M Burns, Alex Bottle, Paul Aylin, Ailsa Hart, Omar Faiz
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引用次数: 0

摘要

背景:炎症性肠病会增加罹患结直肠肿瘤的风险。对于接受过结肠次全切除术并留下直肠残余的患者来说,这尤其是一个问题。必须准确估计未来患直肠癌的风险,并权衡进一步手术或监测的风险。本研究旨在估算此类患者直肠癌的 10 年累积发病率:方法:利用英格兰的医院管理数据开展了一项全国性研究。方法:利用英格兰医院的行政数据进行了一项全国性研究,确定了 2002 年 4 月至 2014 年 3 月间接受结肠次全切除术的患者队列。采用竞争风险生存分析法计算直肠癌的累积发病率。采用时间趋势分析法研究了 COVID-19 大流行对内镜监测的影响:结果:共纳入了 8120 名患者,其中 61 名患者(0.8%)被确诊为癌症。直肠癌的累积发病率在 5 年、10 年和 15 年分别为 0.26%(95% 置信区间为 0.17% 至 0.39%)、0.49%(95% 置信区间为 0.36% 至 0.68%)和 0.77%(95% 置信区间为 0.57% 至 1.02%)。既往诊断为结肠发育不良(HR 3.34,95% 置信区间为 1.01 至 10.97;P = 0.047)、原发性硬化性胆管炎(HR 5.42,95% 置信区间为 1.34 至 21.85;P = 0.018)和选择性结肠切除术(HR 1.83,95% 置信区间为 1.11 至 3.02;P = 0.018)与直肠癌发病率增加有关。在内镜监测方面,2020年进行的内镜手术(333例)与2019年(585例)相比下降了43%:结论:结肠次全切除术后直肠癌的发病率较低。无直肠发育不良证据的无症状患者应仔细咨询预防性直肠切除术可能带来的益处和风险。
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Incidence of rectal cancer after colectomy for inflammatory bowel disease: nationwide study.

Background: Inflammatory bowel disease increases the risk of colorectal neoplasia. A particular problem arises in patients who have undergone subtotal colectomy leaving a rectal remnant. The risk of future rectal cancer must be accurately estimated and weighed against the risks of further surgery or surveillance. The aim of this study was to estimate the 10-year cumulative incidence of rectal cancer in such patients.

Methods: A nationwide study using England's hospital administrative data was performed. A cohort of patients undergoing subtotal colectomy between April 2002 and March 2014 was identified. A competing risks survival analysis was performed to calculate the cumulative incidence of rectal cancer. The effect of the COVID-19 pandemic on endoscopic surveillance was investigated using time-trend analysis.

Results: A total of 8120 patients were included and 61 patients (0.8%) were diagnosed with cancer. The cumulative incidence of rectal cancer was 0.26% (95% c.i. 0.17% to 0.39%), 0.49% (95% c.i. 0.36% to 0.68%), and 0.77% (95% c.i. 0.57% to 1.02%) at 5, 10, and 15 years respectively. A previous diagnosis of colonic dysplasia (HR 3.34, 95% c.i. 1.01 to 10.97; P = 0.047), primary sclerosing cholangitis (HR 5.42, 95% c.i. 1.34 to 21.85; P = 0.018), and elective colectomy (HR 1.83, 95% c.i. 1.11 to 3.02; P = 0.018) was associated with an increased incidence of rectal cancer. Regarding endoscopic surveillance, there was a 43% decline in endoscopic procedures performed in 2020 (333 procedures) compared with 2019 (585 procedures).

Conclusion: The incidence of rectal cancer after subtotal colectomy is low. Asymptomatic patients without evidence of rectal dysplasia should be carefully counselled on the possible benefits and risks of prophylactic proctectomy.

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BJS Open
BJS Open SURGERY-
CiteScore
6.00
自引率
3.20%
发文量
144
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