The fate of the rectum in ulcerative colitis at index surgery and beyond—a contemporary cohort

• Published in: International journal of colorectal disease 2025-01, Vol.40 (1), p.12, Article 12
• Main Authors: Stephens, Ian J. B., Murphy, Brenda, McCawley, Niamh, McNamara, Deborah A., Burke, John P.
• Format: Article
• Language: English
• Subjects: Acuity; Adult; Aged; Colitis, Ulcerative - surgery; Decision making; Female; Gastroenterology; Hepatology; Humans; Inflammatory bowel disease; Internal Medicine; Length of Stay; Male; Medicine; Medicine & Public Health; Middle Aged; Morbidity; Postoperative Complications - etiology; Proctectomy - adverse effects; Proctocolectomy, Restorative - adverse effects; Proctology; Rectum; Rectum - pathology; Rectum - surgery; Retrospective Studies; Surgery; Surveillance; Treatment Outcome; Ulcerative colitis
• ISSN: 1432-1262; 0179-1958; 1432-1262
• DOI: 10.1007/s00384-024-04779-5

Purpose Proctectomy is frequently deferred at index colectomy for ulcerative colitis due to acuity or immunosuppressive treatments. The retained rectum remains symptomatic in over 50% with associated cancer risk. Management options include index or delayed proctectomy with or without restoration of continuity or surveillance. Comparative studies of perioperative outcomes and reasons for retaining the rectum are lacking. Methods This 13-year retrospective cohort assesses the fate of the rectum in 168 ulcerative colitis patients by analysing index proctectomy, staged proctectomy and retained rectal remnant determinants and outcomes. The primary outcome was the fate of the rectum. Secondary analysis included perioperative morbidity, length of stay and decision-making determinants. Results Proctectomy was performed in 69% of patients, with 16.1% at index surgery. Restorative surgery rate was 44%. Index proctectomy patients were older (54 vs 37 years, p