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Changes in the rate of and trends in colectomy for ulcerative colitis during the era of biologics and calcineurin inhibitors based on a Japanese nationwide cohort study

  • Motoi UchinoEmail author
  • Hiroki Ikeuchi
  • Keisuke Hata
  • Satoshi Okada
  • Soichiro Ishihara
  • Koji Morimoto
  • Rikisaburo Sahara
  • Kazuhiro Watanabe
  • Kouhei Fukushima
  • Kenichi Takahashi
  • Hideaki Kimura
  • Keiji Hirata
  • Tsunekazu Mizushima
  • Toshimitsu Araki
  • Masato Kusunoki
  • Riichiro Nezu
  • Sayumi Nakao
  • Michio Itabashi
  • Akira Hirata
  • Heita Ozawa
  • Takashi Ishida
  • Koji Okabayashi
  • Takayuki Yamamoto
  • Toshihiro Noake
  • Junya Arakaki
  • Yusuke Watadani
  • Hiroki Ohge
  • Ryo Futatsuki
  • Kazutaka Koganei
  • Akira Sugita
  • Daijiro Higashi
  • Kitaro Futami
Original Article
  • 108 Downloads

Abstract

Purpose

We evaluated the recent incidence of surgery and the changing surgery trends for ulcerative colitis (UC) in Japan due to the increasing use of anti-tumor necrosis factor (TNF) agents.

Methods

A questionnaire survey was performed to assess the number of surgeries, surgical indications, surgical timing, and immunosuppressive treatments before surgery between 2007 and 2017.

Results

A total of 3801 surgical cases were reported over 11 years. The prevalence of UC surgery decreased over the period studied. The rate of prednisolone (PSL) use did not change. The prevalence of both calcineurin inhibitors (CNIs) and anti-TNF agents increased during the period studied (p < 0.01). The prevalence of urgent/emergent surgery did not change. The most distinctive change in surgical indications was the increase in cancer/dysplasia (CAC), the prevalence of which increased from 20.2% in 2007 to 34.8%.

Conclusion

The prevalence of UC surgery seems to be decreasing according to the increasing rate of anti-TNF agent and CNI administration. However, the indication of CAC significantly increased. Further research should evaluate whether or not long-term remission maintained with several agents can lead to increasing CAC.

Keywords

Ulcerative colitis Colectomy Anti-tumor necrosis factor alpha Calcineurin inhibitor 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interest in association with this study.

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Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Motoi Uchino
    • 1
    Email author
  • Hiroki Ikeuchi
    • 1
  • Keisuke Hata
    • 2
  • Satoshi Okada
    • 2
  • Soichiro Ishihara
    • 2
  • Koji Morimoto
    • 3
  • Rikisaburo Sahara
    • 3
  • Kazuhiro Watanabe
    • 4
  • Kouhei Fukushima
    • 4
  • Kenichi Takahashi
    • 5
  • Hideaki Kimura
    • 6
  • Keiji Hirata
    • 7
  • Tsunekazu Mizushima
    • 8
  • Toshimitsu Araki
    • 9
  • Masato Kusunoki
    • 9
  • Riichiro Nezu
    • 10
    • 11
  • Sayumi Nakao
    • 12
  • Michio Itabashi
    • 12
  • Akira Hirata
    • 13
  • Heita Ozawa
    • 13
  • Takashi Ishida
    • 14
  • Koji Okabayashi
    • 14
  • Takayuki Yamamoto
    • 15
  • Toshihiro Noake
    • 16
  • Junya Arakaki
    • 17
  • Yusuke Watadani
    • 18
  • Hiroki Ohge
    • 18
  • Ryo Futatsuki
    • 19
  • Kazutaka Koganei
    • 19
  • Akira Sugita
    • 19
  • Daijiro Higashi
    • 20
  • Kitaro Futami
    • 20
  1. 1.Department of Inflammatory Bowel Disease, Division of SurgeryHyogo College of MedicineNishinomiyaJapan
  2. 2.Department of Surgical OncologyThe University of TokyoTokyoJapan
  3. 3.Department of ColoproctologyJapan Community Healthcare Organization, Tokyo Yamate Medical CenterTokyoJapan
  4. 4.Department of SurgeryTohoku University Graduate School of MedicineSendaiJapan
  5. 5.Inflammatory Bowel Disease CenterTohoku Rosai HospitalSendaiJapan
  6. 6.Inflammatory Bowel Disease CenterYokohama City University Medical CenterYokohamaJapan
  7. 7.Department of SurgeryUniversity of Occupational and Environmental HealthFukuokaJapan
  8. 8.Department of Therapeutics for Inflammatory Bowel DiseasesOsaka University, Graduate School of MedicineSuitaJapan
  9. 9.Department of Gastrointestinal and Pediatric SurgeryMie University Graduate School of MedicineTsuJapan
  10. 10.Department of SurgeryNishinomiya Municipal Central HospitalNishinomiyaJapan
  11. 11.Department of SurgeryOsaka Rosai HospitalOsakaJapan
  12. 12.Institute of GastroenterologyTokyo Women’s Medical University HospitalTokyoJapan
  13. 13.Departments of Colorectal SurgeryTochigi Cancer CenterUtsunomiyaJapan
  14. 14.Department of SurgeryKeio University School of MedicineTokyoJapan
  15. 15.Department of Surgery & Inflammatory Bowel Disease CentreYokkaichi Hazu Medical CentreYokkaichiJapan
  16. 16.Kurume Coloproctology CenterKurumeJapan
  17. 17.Center for Gastroenterology, Department of SurgeryUrasoe General HospitalUrasoeJapan
  18. 18.Department of SurgeryHiroshima University HospitalHiroshimaJapan
  19. 19.Department of Inflammatory Bowel DiseaseYokohama Municipal Citizen’s HospitalYokohamaJapan
  20. 20.Department of SurgeryFukuoka University Chikushi HospitalChikusinoJapan

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