Segmental Resection versus Total Proctocolectomy for Crohn’s Colitis: What is the Best Operation in the Setting of Medically Refractory Disease or Dysplasia?
Open Access
- 16 February 2018
- journal article
- review article
- Published by Oxford University Press (OUP) in Inflammatory Bowel Diseases
- Vol. 24 (3), 532-538
- https://doi.org/10.1093/ibd/izx064
Abstract
Crohn’s disease (CD) may affect any part of the gastrointestinal tract. When isolated to the colon, and patients become medically refractory, there are several surgical options – segmental resection, subtotal colectomy with ileorectal anastomosis, or a total proctocolectomy and end ileostomy. Unfortunately, surgery does not cure CD, and, regardless of the extent of bowel removed, recurrence may be seen in the small bowel. This may lead to need for further immunosuppression or surgery. Therefore, when appropriate, a segmental colectomy or subtotal colectomy may prevent a permanent ostomy required with a total proctocolectomy. In the setting of dysplasia identified on colonoscopy, low quality evidence guides our treatment paradigms. Even though identification of dysplasia has greatly improved with chromoendoscopy, rates of synchronous or metachronous neoplasm remain high. Thus, a total proctocolectomy and end ileostomy, whereas a larger operation, may be best for the patient to remove all at risk tissue. Further research with prospective or randomized control trials is needed to improve our practice guidelines of both scenarios.Keywords
This publication has 82 references indexed in Scilit:
- Ileal Pouch Anal AnastomosisAnnals of Surgery, 2013
- Local barrier dysfunction identified by confocal laser endomicroscopy predicts relapse in inflammatory bowel diseaseGut, 2011
- Outcome and long‐term function of restorative proctocolectomy for Crohn’s disease: comparison to patients with ulcerative colitisColorectal Disease, 2011
- Narrow-band imaging versus high-definition endoscopy for the diagnosis of neoplasia in ulcerative colitisEndoscopy, 2010
- When should ulcerative colitis patients undergo colectomy for dysplasia? Mismatch between patient preferences and physician recommendationsInflammatory Bowel Diseases, 2010
- Colonoscopic surveillance improves survival after colorectal cancer diagnosis in inflammatory bowel diseaseBritish Journal of Cancer, 2009
- Adalimumab for Maintenance of Clinical Response and Remission in Patients With Crohn’s Disease: The CHARM TrialGastroenterology, 2007
- Long‐term outcomes of restorative proctocolectomy for Crohn's disease and indeterminate colitisColorectal Disease, 2005
- Maintenance infliximab for Crohn's disease: the ACCENT I randomised trialThe Lancet, 2002
- Avoiding a stomaDiseases of the Colon & Rectum, 1997