Jessica Bogach1,2, Gregory Pond3,4, Cagla Eskicioglu4, Marko Simunovic3,4,5, Hsien Seow3,4. 1. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada. bogachj@mcmaster.ca. 2. , Hamilton, Canada. bogachj@mcmaster.ca. 3. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada. 4. Department of Oncology, McMaster University, Hamilton, ON, Canada. 5. Department of Surgery, McMaster University, Hamilton, ON, Canada.
Abstract
BACKGROUND: The extent of surgical resection in inflammatory bowel disease (IBD) patients who develop colorectal cancer (CRC) is not prescribed by guidelines. We aim to evaluate, at a population level, the association of extent of surgical resection with survival outcomes. METHODS: Using a validated Ontario registry of Crohn's disease (CD) and ulcerative colitis (UC) patients, we identified patients who underwent colorectal cancer resection between 2007 and 2015. Patient, tumor, and treatment factors, including type of surgical resection, were collected. Resections were grouped as segmental, total colectomy, and proctocolectomy. Multivariable cox proportional hazard regression was performed to identify factors associated with survival, including extent of surgical resection. RESULTS: Between 2007 and 2015, 84,694 patients had resections for CRC in the province of Ontario, 599 had ulcerative colitis (UC), and 366 had Crohn's disease (CD). Segmental resection was the most common operation performed and was more common in CD patients compared to UC (68% vs. 45.6%, p < 0.001). Five-year survival was 63.7% (95% CI 59.5-67.7) in UC patients and 57.5% (95% CI 51.9-62.7) in CD patients (p = 0.033). Multivariable analysis showed worse survival in patients undergoing total colectomy, compared to segmental resection [HR 1.70 (95% CI 1.31-2.21), p < 0.001]. There was no significant difference in survival between patients undergoing segmental resection and proctocolectomy [HR 0.99 (95% CI 0.78-1.27)]. This pattern was similar within the subtypes of IBD. CONCLUSION: In the setting of IBD-associated CRC, segmental resection and proctocolectomy are associated with similar survival outcomes in both UC and CD patients. Prospective study is essential to explore these findings.
BACKGROUND: The extent of surgical resection in inflammatory bowel disease (IBD) patients who develop colorectal cancer (CRC) is not prescribed by guidelines. We aim to evaluate, at a population level, the association of extent of surgical resection with survival outcomes. METHODS: Using a validated Ontario registry of Crohn's disease (CD) and ulcerative colitis (UC) patients, we identified patients who underwent colorectal cancer resection between 2007 and 2015. Patient, tumor, and treatment factors, including type of surgical resection, were collected. Resections were grouped as segmental, total colectomy, and proctocolectomy. Multivariable cox proportional hazard regression was performed to identify factors associated with survival, including extent of surgical resection. RESULTS: Between 2007 and 2015, 84,694 patients had resections for CRC in the province of Ontario, 599 had ulcerative colitis (UC), and 366 had Crohn's disease (CD). Segmental resection was the most common operation performed and was more common in CD patients compared to UC (68% vs. 45.6%, p < 0.001). Five-year survival was 63.7% (95% CI 59.5-67.7) in UC patients and 57.5% (95% CI 51.9-62.7) in CD patients (p = 0.033). Multivariable analysis showed worse survival in patients undergoing total colectomy, compared to segmental resection [HR 1.70 (95% CI 1.31-2.21), p < 0.001]. There was no significant difference in survival between patients undergoing segmental resection and proctocolectomy [HR 0.99 (95% CI 0.78-1.27)]. This pattern was similar within the subtypes of IBD. CONCLUSION: In the setting of IBD-associated CRC, segmental resection and proctocolectomy are associated with similar survival outcomes in both UC and CD patients. Prospective study is essential to explore these findings.
Authors: Vito Annese; Marco Daperno; Matthew D Rutter; Aurelien Amiot; Peter Bossuyt; James East; Marc Ferrante; Martin Götz; Konstantinos H Katsanos; Ralf Kießlich; Ingrid Ordás; Alessandro Repici; Bruno Rosa; Shaji Sebastian; Torsten Kucharzik; Rami Eliakim Journal: J Crohns Colitis Date: 2013-11-01 Impact factor: 9.071
Authors: David T Rubin; Ashwin N Ananthakrishnan; Corey A Siegel; Bryan G Sauer; Millie D Long Journal: Am J Gastroenterol Date: 2019-03 Impact factor: 10.864
Authors: Stephan Brackmann; Geir Aamodt; Solveig Norheim Andersen; Borghild Roald; Frøydis Langmark; Ole P F Clausen; Erling Aadland; Olav Fausa; Andreas Rydning; Morten H Vatn Journal: Inflamm Bowel Dis Date: 2010-03 Impact factor: 5.325
Authors: Stephan Brackmann; Solveig Norheim Andersen; Geir Aamodt; Borghild Roald; Frøydis Langmark; Ole P F Clausen; Erling Aadland; Olav Fausa; Andreas Rydning; Morten H Vatn Journal: Inflamm Bowel Dis Date: 2009-01 Impact factor: 5.325
Authors: Elana A Maser; David B Sachar; Danielle Kruse; Noam Harpaz; Thomas Ullman; Joel J Bauer Journal: Inflamm Bowel Dis Date: 2013-08 Impact factor: 5.325
Authors: Ana I Robles; Giovanni Traverso; Ming Zhang; Nicholas J Roberts; Mohammed A Khan; Christine Joseph; Gregory Y Lauwers; Florin M Selaru; Maria Popoli; Meredith E Pittman; Xiquan Ke; Ralph H Hruban; Stephen J Meltzer; Kenneth W Kinzler; Bert Vogelstein; Curtis C Harris; Nickolas Papadopoulos Journal: Gastroenterology Date: 2016-01-05 Impact factor: 22.682