Skip to main content

Advertisement

SpringerLink
Log in

Timing of surgery in ulcerative colitis in the biologic therapy era—the patient’s perspective

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

There is no general consensus regarding the ideal timing of surgery in patients with refractory ulcerative colitis (UC). Decision-making and timing of restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is influenced by treating physicians and patients themselves. The aim of this study was to determine whether or not patients would have preferred the operation to be performed earlier, at the same time, or at a later point of time and to determine the reasons for their preference.

Methods

Clinical data of 193 patients with UC who have undergone IPAA were documented in a prospective database at our institution between 2004 and 2015. From this database, 190 patients were identified and a standardized custom-made questionnaire was mailed for follow-up survey. Patients who did not respond were called by telephone and encouraged to complete the questionnaire.

Results

One hundred nine questionnaires were eligible for analysis (57.4%). Average time between diagnosis and surgery was 11.2 ± 10.8 years (mean ± SD). Indications for surgery were refractory disease (70.6%), colitis-associated colorectal cancer (11.0%), high-grade dysplasia or stenosis (11.9%), and septic complications of UC (6.4%); 39 of 77 patients (50.6%) with refractory UC reported to have preferred their operation to be carried out earlier as it was actually performed (16.8 ± 11.9 months). Refractory course of the disease was identified as a predictor for a retrospectively desired earlier surgical approach (p = 0.014).

Conclusion

A substantial proportion of patients felt that they should have undergone surgery earlier than actually performed. It appears that timing of the decision to undergo surgery is suboptimal. This situation may be improved by earlier surgical consultation in the course of the disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

The content of this manuscript is part of your dissertation/thesis which can be accessed on the following link: (http://www.diss.fuberlin.de/diss/servlets/MCRFileNodeServlet/FUDISS_derivate_000000020141/Diss_E.-M.Lorenz.pdf;hosts=local).

References

  1. Porter CK, Welsh M, Riddle MS, Nieh C, Boyko EJ, Gackstetter G, Hooper TI (2017) Epidemiology of inflammatory bowel disease among participants of the millennium cohort: incidence, deployment-related risk factors, and antecedent episodes of infectious gastroenteritis. Aliment Pharmacol Ther 45:1115–1127. https://doi.org/10.1111/apt.13991

    Article  PubMed  CAS  Google Scholar 

  2. Ott C, Obermeier F, Thieler S, Kemptner D, Bauer A, Schölmerich J, Rogler G, Timmer A (2008) The incidence of inflammatory bowel disease in a rural region of southern Germany: a prospective population-based study. Eur J Gastroenterol Hepatol 20:917–923. https://doi.org/10.1097/MEG.0b013e3282f97b33

    Article  PubMed  Google Scholar 

  3. Seifarth C, Börner L, Siegmund B, Buhr HJ, Ritz J-P, Gröne J (2017) Impact of staged surgery on quality of life in refractory ulcerative colitis. Surg Endosc 31:643–649. https://doi.org/10.1007/s00464-016-5010-y

    Article  PubMed  Google Scholar 

  4. Lightner AL, Raffals LE, Mathis KL, Cima RR, Tse CS, Pemberton JH, Dozois EJ, Loftus EV (2017) Postoperative outcomes in vedolizumab-treated patients undergoing abdominal operations for inflammatory bowel disease. J Crohns Colitis 11:185–190. https://doi.org/10.1093/ecco-jcc/jjw147

    Article  PubMed  Google Scholar 

  5. Selvaggi F, Pellino G, Canonico S, Sciaudone G (2015) Effect of preoperative biologic drugs on complications and function after restorative proctocolectomy with primary ileal pouch formation: systematic review and meta-analysis. Inflamm Bowel Dis 21:79–92. https://doi.org/10.1097/MIB.0000000000000232

    Article  PubMed  Google Scholar 

  6. Øresland T, Bemelman WA, Sampietro GM, Spinelli A, Windsor A, Ferrante M, Marteau P, Zmora O, Kotze PG, Espin-Basany E, Tiret E, Sica G, Panis Y, Faerden AE, Biancone L, Angriman I, Serclova Z, de Buck van Overstraeten A, Gionchetti P, Stassen L, Warusavitarne J, Adamina M, Dignass A, Eliakim R, Magro F, D’Hoore A, European Crohn’s and Colitis Organisation (ECCO) (2015) European evidence based consensus on surgery for ulcerative colitis. J Crohns Colitis 9:4–25. https://doi.org/10.1016/j.crohns.2014.08.012

    Article  PubMed  Google Scholar 

  7. Fazio VW, Kiran RP, Remzi FH, Coffey JC, Heneghan HM, Kirat HT, Manilich E, Shen B, Martin ST (2013) Ileal pouch anal anastomosis: analysis of outcome and quality of life in 3707 patients. Ann Surg 257:679–685. https://doi.org/10.1097/SLA.0b013e31827d99a2

    Article  PubMed  Google Scholar 

  8. Heikens JT, de Vries J, Goos MRE, Oostvogel HJ, Gooszen HG, van Laarhoven CJHM (2012) Quality of life and health status before and after ileal pouch-anal anastomosis for ulcerative colitis. Br J Surg 99:263–269. https://doi.org/10.1002/bjs.7711

    Article  PubMed  CAS  Google Scholar 

  9. Andus T (2016) Chronisch-entzündliche Darmerkrankungen Wissenschaft heute – Standard morgen, Koloproktologie UPDATE 2015. Coloproctol Berl Heidelb Dtschl 38:314–325. https://doi.org/10.1007/s00053-015-0064-1

    Article  Google Scholar 

  10. Scott NA, Hughes LE (1994) Timing of ileocolonic resection for symptomatic Crohn’s disease—the patient’s view. Gut 35:656–657

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  11. Neumann P-A, Mennigen RB, Senninger N, Bruewer M, Rijcken E (2012) Timing of restorative proctocolectomy in patients with medically refractory ulcerative colitis: the patient’s point of view. Dis Colon Rectum 55:756–761. https://doi.org/10.1097/DCR.0b013e318251e004

    Article  PubMed  Google Scholar 

  12. Biondi A, Zoccali M, Costa S, Troci A, Contessini-Avesani E, Fichera A (2012) Surgical treatment of ulcerative colitis in the biologic therapy era. World J Gastroenterol 18:1861–1870. https://doi.org/10.3748/wjg.v18.i16.1861

    Article  PubMed  PubMed Central  Google Scholar 

  13. Davaris M, Barnett S, Abouassaly R, Lawrentschuk N (2017) Thoracic surgery information on the internet: a multilingual quality assessment. Interact J Med Res 6:e5. https://doi.org/10.2196/ijmr.6732

    Article  PubMed  PubMed Central  Google Scholar 

  14. Main BG, McNair AGK, Huxtable R, Donovan JL, Thomas SJ, Kinnersley P, Blazeby JM (2017) Core information sets for informed consent to surgical interventions: baseline information of importance to patients and clinicians. BMC Med Ethics 18:29. https://doi.org/10.1186/s12910-017-0188-7

    Article  PubMed  PubMed Central  Google Scholar 

  15. Bernat JL, Peterson LM (2006) Patient-centered informed consent in surgical practice. Arch Surg 141:86–92. https://doi.org/10.1001/archsurg.141.1.86

    Article  PubMed  Google Scholar 

  16. Carmon E, Keidar A, Ravid A, Goldman G, Rabau M (2003) The correlation between quality of life and functional outcome in ulcerative colitis patients after proctocolectomy ileal pouch anal anastomosis. Colorectal Dis 5:228–232

    Article  PubMed  CAS  Google Scholar 

  17. Heuschen UA, Heuschen G, Herfarth C (1998) Quality of life after proctocolectomy for ulcerative colitis. Chir Z Alle Geb Oper Medizen 69:1045–1051

    Article  CAS  Google Scholar 

  18. Ward ST, Li KK, Trivedi PJ, Hejmadi RK, Suggett N, Iqbal T, Ismail T (2013) Patients newly diagnosed with ulcerative colitis receive earlier treatment in surgical clinics. Colorectal Dis 15:836–841. https://doi.org/10.1111/codi.12142

    Article  PubMed  CAS  Google Scholar 

  19. Bewtra M, Kilambi V, Fairchild AO, Siegel CA, Lewis JD, Johnson FR (2014) Patient preferences for surgical versus medical therapy for ulcerative colitis. Inflamm Bowel Dis 20:103–114. https://doi.org/10.1097/01.MIB.0000437498.14804.50

    Article  PubMed  Google Scholar 

  20. Aberra FN, Lewis JD, Hass D, Rombeau JL, Osborne B, Lichtenstein GR (2003) Corticosteroids and immunomodulators: postoperative infectious complication risk in inflammatory bowel disease patients. Gastroenterology 125:320–327

    Article  PubMed  CAS  Google Scholar 

  21. Ferrante M, D’Hoore A, Vermeire S, Declerck S, Noman M, Van Assche G, Hoffman I, Rutgeerts P, Penninckx F (2009) Corticosteroids but not infliximab increase short-term postoperative infectious complications in patients with ulcerative colitis. Inflamm Bowel Dis 15:1062–1070. https://doi.org/10.1002/ibd.20863

    Article  PubMed  CAS  Google Scholar 

  22. Arseneau KO, Sultan S, Provenzale DT, Onken J, Bickston SJ, Foley E, Connors AF, Cominelli F (2006) Do patient preferences influence decisions on treatment for patients with steroid-refractory ulcerative colitis? Clin Gastroenterol Hepatol 4:1135–1142. https://doi.org/10.1016/j.cgh.2006.05.003

    Article  PubMed  Google Scholar 

  23. Thompson KD, Connor SJ, Walls DM, Gollins J, Stewart SK, Bewtra M, Baumblatt GL, Holubar SD, Greenup A-J, Sechi A, Girgis A, Rubin DT, Siegel CA (2016) Patients with ulcerative colitis are more concerned about complications of their disease than side effects of medications. Inflamm Bowel Dis 22:940–947. https://doi.org/10.1097/MIB.0000000000000740

    Article  PubMed  Google Scholar 

  24. Bewtra M, Johnson FR (2013) Assessing patient preferences for treatment options and process of care in inflammatory bowel disease: a critical review of quantitative data. Patient 6:241–255. https://doi.org/10.1007/s40271-013-0031-2

    Article  PubMed  Google Scholar 

  25. Cohan JN, Ozanne EM, Sewell JL, Hofer RK, Mahadevan U, Varma MG, Finlayson E (2016) A novel decision aid for surgical patients with ulcerative colitis: results of a pilot study. Dis Colon Rectum 59:520–528. https://doi.org/10.1097/DCR.0000000000000572

    Article  PubMed  Google Scholar 

  26. Spiegel BMR, Ho W, Esrailian E, Targan S, Higgins PDR, Siegel CA, Dubinsky M, Melmed GY (2009) Controversies in ulcerative colitis: a survey comparing decision making of experts versus community gastroenterologists. Clin Gastroenterol Hepatol 7:168–174, 174.e1. https://doi.org/10.1016/j.cgh.2008.08.029

    Article  PubMed  Google Scholar 

  27. Park KT, Tsai R, Perez F, Cipriano LE, Bass D, Garber AM (2012) Cost-effectiveness of early colectomy with ileal pouch-anal anastamosis versus standard medical therapy in severe ulcerative colitis. Ann Surg 256:117–124. https://doi.org/10.1097/SLA.0b013e3182445321

    Article  PubMed  CAS  Google Scholar 

  28. Prenzler A, Bokemeyer B, Mittendorf T, J-MG v d S (2010) Costs of ulcerative colitis within the German statutory health insurance. Dtsch Med Wochenschr 135:281–286. https://doi.org/10.1055/s-0029-1244848

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Campus Benjamin Franklin, Charité University Medicine, Berlin, Germany

    Jörn Gröne, Eva-Maria Lorenz, Claudia Seifarth, Hendrik Seeliger & Martin E. Kreis

  2. Department of Surgery, Rotes Kreuz Krankenhaus, Bremen, Germany

    Jörn Gröne

  3. Department of Surgery, Vivantes Hospital Neukölln, Rudower Straße 48, 12351, Berlin, Germany

    Mario H. Mueller

Authors
  1. Jörn Gröne
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eva-Maria Lorenz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Claudia Seifarth
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hendrik Seeliger
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Martin E. Kreis
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mario H. Mueller
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mario H. Mueller.

Ethics declarations

Financial disclosure statement

The authors Jörn Gröne, Eva-Maria Lorenz, Claudia Seifarth, Hendrik Seeliger, Martin E. Kreis, and Mario H. Mueller have nothing to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gröne, J., Lorenz, EM., Seifarth, C. et al. Timing of surgery in ulcerative colitis in the biologic therapy era—the patient’s perspective. Int J Colorectal Dis 33, 1429–1435 (2018). https://doi.org/10.1007/s00384-018-3129-0

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-018-3129-0

Keywords

Search

Navigation