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Extent of Surgical Resection in Inflammatory Bowel Disease Associated Colorectal Cancer: a Population-Based Study

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

The extent of surgical resection in inflammatory bowel disease (IBD) patients who develop colorectal cancer (CRC) is not prescribed by guidelines. We aim to evaluate, at a population level, the association of extent of surgical resection with survival outcomes.

Methods

Using a validated Ontario registry of Crohn’s disease (CD) and ulcerative colitis (UC) patients, we identified patients who underwent colorectal cancer resection between 2007 and 2015. Patient, tumor, and treatment factors, including type of surgical resection, were collected. Resections were grouped as segmental, total colectomy, and proctocolectomy. Multivariable cox proportional hazard regression was performed to identify factors associated with survival, including extent of surgical resection.

Results

Between 2007 and 2015, 84,694 patients had resections for CRC in the province of Ontario, 599 had ulcerative colitis (UC), and 366 had Crohn’s disease (CD). Segmental resection was the most common operation performed and was more common in CD patients compared to UC (68% vs. 45.6%, p < 0.001). Five-year survival was 63.7% (95% CI 59.5–67.7) in UC patients and 57.5% (95% CI 51.9–62.7) in CD patients (p = 0.033). Multivariable analysis showed worse survival in patients undergoing total colectomy, compared to segmental resection [HR 1.70 (95% CI 1.31–2.21), p < 0.001]. There was no significant difference in survival between patients undergoing segmental resection and proctocolectomy [HR 0.99 (95% CI 0.78–1.27)]. This pattern was similar within the subtypes of IBD.

Conclusion

In the setting of IBD-associated CRC, segmental resection and proctocolectomy are associated with similar survival outcomes in both UC and CD patients. Prospective study is essential to explore these findings.

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Funding

This study was supported through provision of data by the Institute for Clinical Evaluative Sciences (ICES) and Cancer Care Ontario (CCO) and through funding support to ICES from an annual grant by the Ministry of Health and Long-Term Care (MOHLTC) and the Ontario Institute for Cancer Research (OICR).

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Authors and Affiliations

  1. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada

    Jessica Bogach, Gregory Pond, Marko Simunovic & Hsien Seow

  2. Hamilton, Canada

    Jessica Bogach

  3. Department of Oncology, McMaster University, Hamilton, ON, Canada

    Gregory Pond, Cagla Eskicioglu, Marko Simunovic & Hsien Seow

  4. Department of Surgery, McMaster University, Hamilton, ON, Canada

    Marko Simunovic

Authors
  1. Jessica Bogach
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  2. Gregory Pond
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  3. Cagla Eskicioglu
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  4. Marko Simunovic
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  5. Hsien Seow
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Contributions

All authors made substantial contributions to the study concept, design, data analysis, and interpretation. All authors support the integrity and accuracy of the work. All authors contributed to revision and approval of the final draft of the paper.

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Correspondence to Jessica Bogach.

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The opinions, results and conclusions reported in this paper are those of the authors. No endorsement by ICES, CCO, OICR, or the Government of Ontario is intended or should be inferred.

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Bogach, J., Pond, G., Eskicioglu, C. et al. Extent of Surgical Resection in Inflammatory Bowel Disease Associated Colorectal Cancer: a Population-Based Study. J Gastrointest Surg 25, 2610–2618 (2021). https://doi.org/10.1007/s11605-021-04913-6

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