Motoi Uchino1, Hiroki Ikeuchi2, Keisuke Hata3, Satoshi Okada3, Soichiro Ishihara3, Koji Morimoto4, Rikisaburo Sahara4, Kazuhiro Watanabe5, Kouhei Fukushima5, Kenichi Takahashi6, Hideaki Kimura7, Keiji Hirata8, Tsunekazu Mizushima9, Toshimitsu Araki10, Masato Kusunoki10, Riichiro Nezu11,12, Sayumi Nakao13, Michio Itabashi13, Akira Hirata14, Heita Ozawa14, Takashi Ishida15, Koji Okabayashi15, Takayuki Yamamoto16, Toshihiro Noake17, Junya Arakaki18, Yusuke Watadani19, Hiroki Ohge19, Ryo Futatsuki20, Kazutaka Koganei20, Akira Sugita20, Daijiro Higashi21, Kitaro Futami21. 1. Department of Inflammatory Bowel Disease, Division of Surgery, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, 663-8501, Hyogo, Japan. uchino2s@hyo-med.ac.jp. 2. Department of Inflammatory Bowel Disease, Division of Surgery, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, 663-8501, Hyogo, Japan. 3. Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan. 4. Department of Coloproctology, Japan Community Healthcare Organization, Tokyo Yamate Medical Center, Tokyo, Japan. 5. Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan. 6. Inflammatory Bowel Disease Center, Tohoku Rosai Hospital, Sendai, Japan. 7. Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan. 8. Department of Surgery, University of Occupational and Environmental Health, Fukuoka, Japan. 9. Department of Therapeutics for Inflammatory Bowel Diseases, Osaka University, Graduate School of Medicine, Suita, Osaka, Japan. 10. Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan. 11. Department of Surgery, Nishinomiya Municipal Central Hospital, Nishinomiya, Japan. 12. Department of Surgery, Osaka Rosai Hospital, Osaka, Japan. 13. Institute of Gastroenterology, Tokyo Women's Medical University Hospital, Tokyo, Japan. 14. Departments of Colorectal Surgery, Tochigi Cancer Center, Utsunomiya, Japan. 15. Department of Surgery, Keio University School of Medicine, Tokyo, Japan. 16. Department of Surgery & Inflammatory Bowel Disease Centre, Yokkaichi Hazu Medical Centre, Yokkaichi, Japan. 17. Kurume Coloproctology Center, Kurume, Japan. 18. Center for Gastroenterology, Department of Surgery, Urasoe General Hospital, Urasoe, Japan. 19. Department of Surgery, Hiroshima University Hospital, Hiroshima, Japan. 20. Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, Yokohama, Japan. 21. Department of Surgery, Fukuoka University Chikushi Hospital, Chikusino, Japan.
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.
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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