Pouch functional outcomes after restorative proctocolectomy with ileal-pouch reconstruction in patients with ulcerative colitis: Japanese multi-center nationwide cohort study View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2017-09-07

AUTHORS

Motoi Uchino, Hiroki Ikeuchi, Akira Sugita, Kitaro Futami, Toshiaki Watanabe, Kouhei Fukushima, Kenji Tatsumi, Kazutaka Koganei, Hideaki Kimura, Keisuke Hata, Kenichi Takahashi, Kazuhiro Watanabe, Tsunekazu Mizushima, Yuji Funayama, Daijiro Higashi, Toshimitsu Araki, Masato Kusunoki, Takeshi Ueda, Fumikazu Koyama, Michio Itabashi, Riichiro Nezu, Yasuo Suzuki, On behalf of a research grant on intractable disease affiliated with the Japan Ministry of Health Labor Welfare

ABSTRACT

BackgroundAlthough several complications capable of causing pouch failure may develop after restorative proctocolectomy (RPC) for ulcerative colitis (UC), the incidences and causes are conflicting and vary according to country, race and institution. To avoid pouch failure, this study aimed to evaluate the rate of pouch failure and its risk factors in UC patients over the past decade via a nationwide cohort study.MethodsWe conducted a retrospective, observational, multicenter study that included 13 institutions in Japan. Patients who underwent RPC between January 2005 and December 2014 were included. The characteristics and backgrounds of the patients before and during surgery and their postoperative courses and complications were reviewed.ResultsA total of 2376 patients were evaluated over 6.7 ± 3.5 years of follow-up. Twenty-seven non-functional pouches were observed, and the functional pouch rate was 98.9% after RPC. Anastomotic leakage (odds ratio, 9.1) was selected as a risk factor for a non-functional pouch. The cumulative pouch failure rate was 4.2%/10 years. A change in diagnosis to Crohn’s disease/indeterminate colitis (hazard ratio, 13.2) was identified as an independent risk factor for pouch failure.ConclusionThe significant risk factor for a non-functional pouch was anastomotic leakage. The optimal staged surgical procedure should be selected according to a patient’s condition to avoid anastomotic failure during RPC. Changes in diagnosis after RPC confer a substantial risk of pouch failure. Additional cohort studies are needed to obtain an understanding of the long-standing clinical course of and proper treatment for pouch failure. More... »

PAGES

642-651

References to SciGraph publications

  • 2010-03-09. Surgery for ulcerative colitis in 1,000 patients in INTERNATIONAL JOURNAL OF COLORECTAL DISEASE
  • 2003-10-01. Management of Crohn's disease of the ileoanal pouch with infliximab in THE AMERICAN JOURNAL OF GASTROENTEROLOGY
  • Journal

    TITLE

    Journal of Gastroenterology

    ISSUE

    5

    VOLUME

    53

    Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/s00535-017-1389-z

    DOI

    http://dx.doi.org/10.1007/s00535-017-1389-z

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1091504191

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/28884201


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        "description": "BackgroundAlthough several complications capable of causing pouch failure may develop after restorative proctocolectomy (RPC) for ulcerative colitis (UC), the incidences and causes are conflicting and vary according to country, race and institution. To avoid pouch failure, this study aimed to evaluate the rate of pouch failure and its risk factors in UC patients over the past decade via a nationwide cohort study.MethodsWe conducted a retrospective, observational, multicenter study that included 13 institutions in Japan. Patients who underwent RPC between January 2005 and December 2014 were included. The characteristics and backgrounds of the patients before and during surgery and their postoperative courses and complications were reviewed.ResultsA total of 2376 patients were evaluated over 6.7\u00a0\u00b1\u00a03.5\u00a0years of follow-up. Twenty-seven non-functional pouches were observed, and the functional pouch rate was 98.9% after RPC. Anastomotic leakage (odds ratio, 9.1) was selected as a risk factor for a non-functional pouch. The cumulative pouch failure rate was 4.2%/10\u00a0years. A change in diagnosis to Crohn\u2019s disease/indeterminate colitis (hazard ratio, 13.2) was identified as an independent risk factor for pouch failure.ConclusionThe significant risk factor for a non-functional pouch was anastomotic leakage. The optimal staged surgical procedure should be selected according to a patient\u2019s condition to avoid anastomotic failure during RPC. Changes in diagnosis after RPC confer a substantial risk of pouch failure. Additional cohort studies are needed to obtain an understanding of the long-standing clinical course of and proper treatment for pouch failure.", 
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