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

  • Original Article—Alimentary Tract
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Abstract

Background

Although 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.

Methods

We 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.

Results

A 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.

Conclusion

The 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.

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Acknowledgements

This work was supported in part by Health and Labor Science Research Grants for research on intractable diseases from the Ministry of Health, Labor and Welfare of Japan. M. Itabashi received an honorarium from Bayer Yakuhin, Ltd., and a research grant from Takeda Parmaceutical Co. and Chugai Pharmaceutical Co., Ltd. T. Watanabe received a research grant from Mitsubishi Tanabe Pharm. Y. Suzuki received an honorarium from Mitsubishi Tanabe Pharma Corp., ZERIA Pnarmaceutical Co., Ltd., and AbbVie GK., Eisai Co., Ltd., KYORIN Pharmaceutical Co., Ltd.

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MU, HI, AS, KF, TW and KF designed the study and wrote the initial draft of the manuscript. MU contributed to the analysis and interpretation of data and assisted in the preparation of the manuscript. All other authors contributed to data collection and interpretation and reviewed the manuscript. The final version of the manuscript was approved by all authors.

Corresponding author

Correspondence to Motoi Uchino.

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The other authors declare that they have no potential conflicts of interest.

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Uchino, M., Ikeuchi, H., Sugita, A. et al. Pouch functional outcomes after restorative proctocolectomy with ileal-pouch reconstruction in patients with ulcerative colitis: Japanese multi-center nationwide cohort study. J Gastroenterol 53, 642–651 (2018). https://doi.org/10.1007/s00535-017-1389-z

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  • DOI: https://doi.org/10.1007/s00535-017-1389-z

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