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A Comparison of Adverse Events and Functional Outcomes After Restorative Proctocolectomy for Familial Adenomatous Polyposis and Ulcerative Colitis

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Diseases of the Colon & Rectum

Purpose

Restorative proctocolectomy is the procedure of choice for patients undergoing proctocolectomy for familial adenomatous polyposis or ulcerative colitis. This meta-analysis was designed to identify differences in adverse events and functional outcomes between these two groups.

Methods

Studies published between 1986 and 2003 that compared outcomes between patients with familial adenomatous polyposis and ulcerative colitis were included. Meta-analytical techniques using random effect models were used to compare short-term and long-term adverse events as well as functional outcomes between the groups.

Results

Nineteen studies comprising 5,199 patients (familial adenomatous polyposis, 782; ulcerative colitis, 4,417) were analyzed. There were no significant differences in immediate postoperative adverse events between the two groups. Pouch-related fistulation was significantly increased in the ulcerative colitis group (10.5 percent vs. familial adenomatous polyposis 4.8 percent; odds ratio 2.31; P < 0.001). There was no significant difference in pouch failure between the two groups (ulcerative colitis 5.8 percent vs. familial adenomatous polyposis 4.5 percent; odds ratio 1.22; P = 0.43). The incidence of pouchitis was significantly greater in the ulcerative colitis group (30.1 vs. 5.5 percent; odds ratio 6.44; P < 0.001). Patients with familial adenomatous polyposis had a significant advantage in stool frequency with one less motion per 24 hours (95 percent confidence interval, 0.21–1.76; P = 0.01).

Conclusions

In contrast to studies reporting similar outcomes for patients undergoing restorative proctocolectomy for familial adenomatous polyposis or ulcerative colitis, the present meta-analysis suggested that patients with ulcerative colitis are at greater risk of pouch-related fistulation and pouchitis. Although there was an increase in the 24-hour stool frequency in the ulcerative colitis group, this may be accounted for by the younger age at surgery in the familial adenomatous polyposis group.

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Authors and Affiliations

  1. Imperial College London, Department of Biosurgery and Surgical Technology, St. Mary’s Hospital, London, United Kingdom

    Richard E. Lovegrove M.R.C.S., Henry S. Tilney M.R.C.S., Alexander G. Heriot M.D., Alexander C. von Roon M.R.C.S., Thanos Athanasiou M.D. & Paris P. Tekkis M.D., F.R.C.S.

  2. Department of Colorectal Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, USA

    Alexander G. Heriot M.D., James Church M.D., Victor W. Fazio M.B., M.S. & Paris P. Tekkis M.D., F.R.C.S.

  3. Imperial College London, Department of Biosurgery and Surgical Technology, St. Mary’s Hospital, 10th Floor QEQM Building, Praed Street, London, W2 1NY, United Kingdom

    Paris P. Tekkis M.D., F.R.C.S.

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  1. Richard E. Lovegrove M.R.C.S.
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  2. Henry S. Tilney M.R.C.S.
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  3. Alexander G. Heriot M.D.
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  4. Alexander C. von Roon M.R.C.S.
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  5. Thanos Athanasiou M.D.
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  6. James Church M.D.
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  7. Victor W. Fazio M.B., M.S.
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  8. Paris P. Tekkis M.D., F.R.C.S.
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Correspondence to Paris P. Tekkis M.D., F.R.C.S..

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Henry S. Tilney is sponsored by a research grant from The Royal College of Surgeons of England.

Read at the meeting of the Association of Surgeons of Great Britain and Ireland, Edinburgh, Scotland, May 3 to 5, 2006.

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Lovegrove, R.E., Tilney, H.S., Heriot, A.G. et al. A Comparison of Adverse Events and Functional Outcomes After Restorative Proctocolectomy for Familial Adenomatous Polyposis and Ulcerative Colitis. Dis Colon Rectum 49, 1293–1306 (2006). https://doi.org/10.1007/s10350-006-0608-0

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