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Segmental, total abdominal colectomy appears safe for IBD-related neoplasia
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ORLANDO — Segmental and total abdominal colectomy followed by active surveillance appears to be a safe and effective management strategy for patients with IBD-related colonic neoplasia, according to a poster presentation at the 2015 Advances in IBD Meeting.
“This is a follow-up to our study presented at DDW this year— now in press — in which we evaluated how well we were able to detect neoplasia with high definition scopes in patients with IBD who underwent colectomy, and based on the colectomy specimens we demonstrated that we were able to visualize neoplasia and did not miss any cancers,” Noa Krugliak Cleveland, MD, from the University of Chicago Medicine Inflammatory Bowel Disease Center, told Healio Gastroenterology. “In this study we followed the subset of patients who had segmental resections rather than the traditional total proctocolectomy to determine if segmental resections are safe.”
Noa Krugliak Cleveland
In this retrospective review, Cleveland and colleagues identified 11 Crohn’s disease and six UC patients who underwent segmental or total abdominal colectomy for neoplasia. The median age was 64 years (range, 40-78 years), median disease duration was 20.5 years (range, 5-46 years), low-grade dysplasia was the indication for surgery in six of the Crohn’s patients and five of the UC patients, high-grade dysplasia was the indication in two of the Crohn’s patients and one of the UC patients, and adenocarcinoma was the indication in three of the Crohn’s patients.
Five of the UC patients underwent total abdominal colectomy with ileo-rectal anastomosis and 11 of the Crohn’s patients and one UC patient underwent segmental colectomy. Median follow-up was 17 months (range, 2-228 months), during which time patients underwent a median of two (range, 1-8) follow-up endoscopies with high-definition scopes.
Low-grade dysplasia was detected in four Crohn’s patients, and no cancers were detected.
“Of those who had segmental resection only four had low-grade dysplasia found, and the rest had no neoplasia found during follow-up surveillance colonoscopy,” Cleveland said. “Our study suggests that segmental resection along with active surveillance is a safe approach and should be considered in patients with neoplasia as opposed to having a total proctocolectomy.”
Notably, “the only patients who had metachronous dysplasia were [Crohn’s disease] patients with larger segments of retained colon,” Cleveland and colleagues wrote. “We believe that segmental or subtotal colectomies can offer an improved quality of life without compromising cancer prevention strategies.” – by Adam Leitenberger
Reference: Cleveland NK, et al. Abstract P-031. Presented at Advances in Inflammatory Bowel Diseases; Dec. 10-12, 2015; Orlando, Fla.
Disclosures: Cleveland reports no relevant financial disclosures.