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Trends in Colectomies for Colorectal Neoplasms in Ulcerative Colitis: a National Inpatient Sample Database Analysis over Two Decades

  • SSAT Plenary Presentation
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Rates of colectomy for ulcerative colitis have been decreasing, particularly since the advent of biologics, but the subsequent impact of reduced colectomy rates on the development of neoplasms in chronically treated ulcerative colitis colons is unknown.

Purpose

To determine trends in colectomy for colorectal neoplasms in adult patients with ulcerative colitis.

Methods

Adult admissions with ulcerative colitis were identified from the National Inpatient Sample from 1993 to 2015. The rate of colectomy with concurrent colorectal neoplasm served as the primary outcome and was evaluated using time trend linear and multivariable regression.

Results

There were 366,286 admissions with ulcerative colitis including 16,556 (4.5%) total colectomies. Of those undergoing colectomy, 2018 (12.2%) had a concurrent diagnosis of colorectal neoplasm. The proportion of colectomies for ulcerative colitis with concurrent colorectal neoplasm increased from 10.3 to 12.5% (pTrend = 0.004). Specifically, the proportion of colectomies performed for dysplasia/benign neoplasm and rectal cancer increased from 3.5 to 5.6% (pTrend < 0.001) and from 2.6 to 3.0% (pTrend = 0.028) respectively, and those for colon cancer remained stable (4.5 to 3.9%, pTrend = 0.423). On multivariate regression, year of colectomy was a significant predictor of colectomy for colorectal neoplasm (OR = 1.044, 95% CI = 1.025–1.062).

Discussion

Operative management of ulcerative colitis appears to be slowly increasing in oncological indications. The rising proportions of colectomies performed for colorectal neoplasms suggest the need for continued screening in these patients, including rectal surveillance.

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Authors and Affiliations

  1. Faculty of Medicine, McGill University, Montreal, Quebec, Canada

    Alexander Ni, Mohammed Al-Qahtani, Ebram Salama, Maria Abou Khalil, Julio Faria, Nancy Morin, Gabriela Ghitulescu, Carol-Ann Vasilevsky & Marylise Boutros

  2. Division of Colon and Rectal Surgery, Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Suite G317, Montreal, H3T 1E2, Quebec, Canada

    Alexander Ni, Mohammed Al-Qahtani, Ebram Salama, Daniel Marinescu, Maria Abou Khalil, Julio Faria, Nancy Morin, Gabriela Ghitulescu, Carol-Ann Vasilevsky & Marylise Boutros

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  1. Alexander Ni
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  2. Mohammed Al-Qahtani
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  10. Marylise Boutros
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Corresponding author

Correspondence to Marylise Boutros.

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Our study received institutional review board exemption from the Jewish General Hospital Ethics Board.

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The authors declare that they have no conflict of interest.

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Work presented as SSAT Plenary Session, Digestive Disease Week on May 19, 2019 in San Diego, CA. Small Bowel & Colorectal Plenary Session I(3570), Presentation # 395.

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Ni, A., Al-Qahtani, M., Salama, E. et al. Trends in Colectomies for Colorectal Neoplasms in Ulcerative Colitis: a National Inpatient Sample Database Analysis over Two Decades. J Gastrointest Surg 24, 1721–1728 (2020). https://doi.org/10.1007/s11605-020-04666-8

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