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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

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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.

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Authors and Affiliations

  1. Department of Inflammatory Bowel Disease, Division of Surgery, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, 663-8501, Hyogo, Japan

    Motoi Uchino & Hiroki Ikeuchi

  2. Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan

    Keisuke Hata, Satoshi Okada & Soichiro Ishihara

  3. Department of Coloproctology, Japan Community Healthcare Organization, Tokyo Yamate Medical Center, Tokyo, Japan

    Koji Morimoto & Rikisaburo Sahara

  4. Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan

    Kazuhiro Watanabe & Kouhei Fukushima

  5. Inflammatory Bowel Disease Center, Tohoku Rosai Hospital, Sendai, Japan

    Kenichi Takahashi

  6. Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan

    Hideaki Kimura

  7. Department of Surgery, University of Occupational and Environmental Health, Fukuoka, Japan

    Keiji Hirata

  8. Department of Therapeutics for Inflammatory Bowel Diseases, Osaka University, Graduate School of Medicine, Suita, Osaka, Japan

    Tsunekazu Mizushima

  9. Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan

    Toshimitsu Araki & Masato Kusunoki

  10. Department of Surgery, Nishinomiya Municipal Central Hospital, Nishinomiya, Japan

    Riichiro Nezu

  11. Department of Surgery, Osaka Rosai Hospital, Osaka, Japan

    Riichiro Nezu

  12. Institute of Gastroenterology, Tokyo Women’s Medical University Hospital, Tokyo, Japan

    Sayumi Nakao & Michio Itabashi

  13. Departments of Colorectal Surgery, Tochigi Cancer Center, Utsunomiya, Japan

    Akira Hirata & Heita Ozawa

  14. Department of Surgery, Keio University School of Medicine, Tokyo, Japan

    Takashi Ishida & Koji Okabayashi

  15. Department of Surgery & Inflammatory Bowel Disease Centre, Yokkaichi Hazu Medical Centre, Yokkaichi, Japan

    Takayuki Yamamoto

  16. Kurume Coloproctology Center, Kurume, Japan

    Toshihiro Noake

  17. Center for Gastroenterology, Department of Surgery, Urasoe General Hospital, Urasoe, Japan

    Junya Arakaki

  18. Department of Surgery, Hiroshima University Hospital, Hiroshima, Japan

    Yusuke Watadani & Hiroki Ohge

  19. Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen’s Hospital, Yokohama, Japan

    Ryo Futatsuki, Kazutaka Koganei & Akira Sugita

  20. Department of Surgery, Fukuoka University Chikushi Hospital, Chikusino, Japan

    Daijiro Higashi & Kitaro Futami

Authors
  1. Motoi Uchino
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  2. Hiroki Ikeuchi
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  3. Keisuke Hata
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  11. Hideaki Kimura
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  14. Toshimitsu Araki
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  16. Riichiro Nezu
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  17. Sayumi Nakao
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  18. Michio Itabashi
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  19. Akira Hirata
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  20. Heita Ozawa
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  21. Takashi Ishida
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  23. Takayuki Yamamoto
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  24. Toshihiro Noake
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  25. Junya Arakaki
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  26. Yusuke Watadani
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  27. Hiroki Ohge
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  28. Ryo Futatsuki
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  29. Kazutaka Koganei
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  30. Akira Sugita
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  31. Daijiro Higashi
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  32. Kitaro Futami
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Corresponding author

Correspondence to Motoi Uchino.

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

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Uchino, M., Ikeuchi, H., Hata, K. et al. 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. Surg Today 49, 1066–1073 (2019). https://doi.org/10.1007/s00595-019-01845-2

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  • DOI: https://doi.org/10.1007/s00595-019-01845-2

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