Primary versus staged reconstruction and risk of surgical failure in patients with ulcerative colitis:a nation-wide co hort study
[Background] Restorative surgery after colectomy due to ulcerative colitis (UC) may be performed simultaneously with colectomy (primary) or as a staged procedure. Risk factors for failure after restorative surgery are not fully explored. This study aimed to compare the risk of failure after primary...
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| Language: | zho |
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Editorial Office of Journal of Colorectal & Anal Surgery
2022-02-01
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| Series: | 结直肠肛门外科 |
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| Online Access: | https://jcas.gxmuyfy.cn/cn/wqll/paper.html?id=470&cateName=2022%E5%B9%B4%20%E7%AC%AC28%E5%8D%B7%20%E7%AC%AC1%E6%9C%9F |
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| author | Fu Zhaoyuan |
| author_facet | Fu Zhaoyuan |
| author_sort | Fu Zhaoyuan |
| collection | DOAJ |
| description | [Background] Restorative surgery after colectomy due to ulcerative colitis (UC) may be performed simultaneously with colectomy (primary) or as a staged procedure. Risk factors for failure after restorative surgery are not fully explored. This study aimed to compare the risk of failure after primary and staged reconstruction. [Methods] This is a national register-based cohort study of all patients 15 to 69 years old in Sweden treated with colectomy due to UC and who received an ileorectal anastomosis (IRA) or ileal pouch-anal anastomosis (IPAA) between 1997 and 2017. Failure was defined as a reoperation with new ileostomy after restorative surgery or a remaining defunctioning ileostomy after 2 years. Risk of failure was calculated using the Kaplan-Meier method and Cox regression adjusted for sex, age, calendar period, primary sclerosing cholangitis, and duration of UC. [Results] Of 2172 included patients, 843 (38.8%) underwent primary reconstruction, and 1329 (61.2%) staged reconstruction. Staged reconstruction was associated with a decreased risk of failure compared with primary reconstruction (hazard ratio, 0.73; 95% CI, 0.58-0.91). The 10-year cumulative risk of failure was 15% vs 20% after staged and primary reconstruction, respectively. In all, 1141 patients (52.5%) received an IPAA and 1031 (47.5%) an IRA. In stratified multivariable models, staged reconstruction was more successful than primary reconstruction in both IRA (hazard ratio, 0.75; 95% CI, 0.54-1.04) and IPAA (hazard ratio, 0.73; 95% CI, 0.52-1.01), although risk estimates failed to attain statistical significance. [Conclusions] In UC patients undergoing colectomy, postponing restorative surgery may decrease the risk of failure. |
| format | Article |
| id | doaj-art-4ae4dce1b60249cbbbac99e362f6c76a |
| institution | DOAJ |
| issn | 1674-0491 |
| language | zho |
| publishDate | 2022-02-01 |
| publisher | Editorial Office of Journal of Colorectal & Anal Surgery |
| record_format | Article |
| series | 结直肠肛门外科 |
| spelling | doaj-art-4ae4dce1b60249cbbbac99e362f6c76a2025-08-20T02:43:50ZzhoEditorial Office of Journal of Colorectal & Anal Surgery结直肠肛门外科1674-04912022-02-01281848510.19668/j.cnki.issn1674-0491.2022.01.022Primary versus staged reconstruction and risk of surgical failure in patients with ulcerative colitis:a nation-wide co hort studyFu Zhaoyuan0Department of Gastroenterology, Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou, Gansu 730000[Background] Restorative surgery after colectomy due to ulcerative colitis (UC) may be performed simultaneously with colectomy (primary) or as a staged procedure. Risk factors for failure after restorative surgery are not fully explored. This study aimed to compare the risk of failure after primary and staged reconstruction. [Methods] This is a national register-based cohort study of all patients 15 to 69 years old in Sweden treated with colectomy due to UC and who received an ileorectal anastomosis (IRA) or ileal pouch-anal anastomosis (IPAA) between 1997 and 2017. Failure was defined as a reoperation with new ileostomy after restorative surgery or a remaining defunctioning ileostomy after 2 years. Risk of failure was calculated using the Kaplan-Meier method and Cox regression adjusted for sex, age, calendar period, primary sclerosing cholangitis, and duration of UC. [Results] Of 2172 included patients, 843 (38.8%) underwent primary reconstruction, and 1329 (61.2%) staged reconstruction. Staged reconstruction was associated with a decreased risk of failure compared with primary reconstruction (hazard ratio, 0.73; 95% CI, 0.58-0.91). The 10-year cumulative risk of failure was 15% vs 20% after staged and primary reconstruction, respectively. In all, 1141 patients (52.5%) received an IPAA and 1031 (47.5%) an IRA. In stratified multivariable models, staged reconstruction was more successful than primary reconstruction in both IRA (hazard ratio, 0.75; 95% CI, 0.54-1.04) and IPAA (hazard ratio, 0.73; 95% CI, 0.52-1.01), although risk estimates failed to attain statistical significance. [Conclusions] In UC patients undergoing colectomy, postponing restorative surgery may decrease the risk of failure.https://jcas.gxmuyfy.cn/cn/wqll/paper.html?id=470&cateName=2022%E5%B9%B4%20%E7%AC%AC28%E5%8D%B7%20%E7%AC%AC1%E6%9C%9Ffailureileal pouch anal anastomosisileorectal anastomosisrestorative surgeryulcerative colitis |
| spellingShingle | Fu Zhaoyuan Primary versus staged reconstruction and risk of surgical failure in patients with ulcerative colitis:a nation-wide co hort study 结直肠肛门外科 failure ileal pouch anal anastomosis ileorectal anastomosis restorative surgery ulcerative colitis |
| title | Primary versus staged reconstruction and risk of surgical failure in patients with ulcerative colitis:a nation-wide co hort study |
| title_full | Primary versus staged reconstruction and risk of surgical failure in patients with ulcerative colitis:a nation-wide co hort study |
| title_fullStr | Primary versus staged reconstruction and risk of surgical failure in patients with ulcerative colitis:a nation-wide co hort study |
| title_full_unstemmed | Primary versus staged reconstruction and risk of surgical failure in patients with ulcerative colitis:a nation-wide co hort study |
| title_short | Primary versus staged reconstruction and risk of surgical failure in patients with ulcerative colitis:a nation-wide co hort study |
| title_sort | primary versus staged reconstruction and risk of surgical failure in patients with ulcerative colitis a nation wide co hort study |
| topic | failure ileal pouch anal anastomosis ileorectal anastomosis restorative surgery ulcerative colitis |
| url | https://jcas.gxmuyfy.cn/cn/wqll/paper.html?id=470&cateName=2022%E5%B9%B4%20%E7%AC%AC28%E5%8D%B7%20%E7%AC%AC1%E6%9C%9F |
| work_keys_str_mv | AT fuzhaoyuan primaryversusstagedreconstructionandriskofsurgicalfailureinpatientswithulcerativecolitisanationwidecohortstudy |