Motoi Uchino1, Hiroki Ikeuchi2, Akira Sugita3, Kitaro Futami4, Toshiaki Watanabe5, Kouhei Fukushima6, Kenji Tatsumi3, Kazutaka Koganei3, Hideaki Kimura7, Keisuke Hata8, Kenichi Takahashi9, Kazuhiro Watanabe10, Tsunekazu Mizushima11, Yuji Funayama12, Daijiro Higashi4, Toshimitsu Araki13, Masato Kusunoki13, Takeshi Ueda14, Fumikazu Koyama14, Michio Itabashi15, Riichiro Nezu16, Yasuo Suzuki17. 1. Department of Inflammatory Bowel Disease, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan. uchino2s@hyo-med.ac.jp. 2. Department of Inflammatory Bowel Disease, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan. 3. Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, Yokohama, Japan. 4. Department of Surgery, Fukuoka University Chikushi Hospital, Chikusino, Japan. 5. Department of Surgical Oncology and Vascular Surgery, The University of Tokyo, Tokyo, Japan. 6. Laboratory of Gastro Intestinal Tract Reconstruction, Tohoku University Graduate School of Biomedical Engineering, Sendai, Japan. 7. Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan. 8. Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan. 9. Coloproctology Center, Tohoku Rosai Hospital, Sendai, Japan. 10. Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan. 11. Department of Therapeutics for Inflammatory Bowel Diseases, Osaka University Graduate School of Medicine, Suita, Japan. 12. Department of Surgery, Sendai Red Cross Hospital, Sendai, Japan. 13. Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan. 14. Department of Surgery, Nara Medical University, Kashihara, Japan. 15. Institute of Gastroenterology, Tokyo Women's Medical University Hospital, Tokyo, Japan. 16. Department of Surgery, Nishinomiya Municipal Central Hospital, Nishinomiya, Japan. 17. Department of Internal Medicine, Toho University Sakura Medical Center, Sakura, Japan.
Abstract
BACKGROUND: Although several complications capable of causing pouch failure may develop after restorative proctocolectomy (RPC) for ulcerative colitis (UC), the incidences and causes are conflicting and vary according to country, race and institution. To avoid pouch failure, this study aimed to evaluate the rate of pouch failure and its risk factors in UC patients over the past decade via a nationwide cohort study. METHODS: We conducted a retrospective, observational, multicenter study that included 13 institutions in Japan. Patients who underwent RPC between January 2005 and December 2014 were included. The characteristics and backgrounds of the patients before and during surgery and their postoperative courses and complications were reviewed. RESULTS: A total of 2376 patients were evaluated over 6.7 ± 3.5 years of follow-up. Twenty-seven non-functional pouches were observed, and the functional pouch rate was 98.9% after RPC. Anastomotic leakage (odds ratio, 9.1) was selected as a risk factor for a non-functional pouch. The cumulative pouch failure rate was 4.2%/10 years. A change in diagnosis to Crohn's disease/indeterminate colitis (hazard ratio, 13.2) was identified as an independent risk factor for pouch failure. CONCLUSION: The significant risk factor for a non-functional pouch was anastomotic leakage. The optimal staged surgical procedure should be selected according to a patient's condition to avoid anastomotic failure during RPC. Changes in diagnosis after RPC confer a substantial risk of pouch failure. Additional cohort studies are needed to obtain an understanding of the long-standing clinical course of and proper treatment for pouch failure.
BACKGROUND: Although several complications capable of causing pouch failure may develop after restorative proctocolectomy (RPC) for ulcerative colitis (UC), the incidences and causes are conflicting and vary according to country, race and institution. To avoid pouch failure, this study aimed to evaluate the rate of pouch failure and its risk factors in UC patients over the past decade via a nationwide cohort study. METHODS: We conducted a retrospective, observational, multicenter study that included 13 institutions in Japan. Patients who underwent RPC between January 2005 and December 2014 were included. The characteristics and backgrounds of the patients before and during surgery and their postoperative courses and complications were reviewed. RESULTS: A total of 2376 patients were evaluated over 6.7 ± 3.5 years of follow-up. Twenty-seven non-functional pouches were observed, and the functional pouch rate was 98.9% after RPC. Anastomotic leakage (odds ratio, 9.1) was selected as a risk factor for a non-functional pouch. The cumulative pouch failure rate was 4.2%/10 years. A change in diagnosis to Crohn's disease/indeterminate colitis (hazard ratio, 13.2) was identified as an independent risk factor for pouch failure. CONCLUSION: The significant risk factor for a non-functional pouch was anastomotic leakage. The optimal staged surgical procedure should be selected according to a patient's condition to avoid anastomotic failure during RPC. Changes in diagnosis after RPC confer a substantial risk of pouch failure. Additional cohort studies are needed to obtain an understanding of the long-standing clinical course of and proper treatment for pouch failure.
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