Ian Stephens1, Brenda Murphy1, Lucy Burns1, Enda Hannan2, Andrew Carroll3, Maeve O’Neill4, Caroline Drumm4, Tom McIntyre5, Liam Costello5, Ibinabo Gabriel Browne6, Shaddin Abushara6, Kysha Wong Sze Xian6, Jennifer McGarry7, Blathnaid Keyes7, Matthew Davey8, Abdulrahman Rudwan9, Mahmod Bashir9, Lena Dablouk9, Ahmed Taha10, Aisha Mohamed10, Kristali Ylli10, Abdurazig Salih11, Shima Ahmed11, Eltahir Eligani11, Ahmed Elmakki1,11, Vikram Tewetia12, Ola Falade12, James Sweeney12, Aine O’Neill13, Yasmine Roden13, Nitish Dasmuth14, Des Toomey7,14, Eleanor Faul1,13, David Kearney1,12, Peter Neary11, Shane Killeen9,10, Emmet Andrews9, Colin Peirce8, Ronan Cahill7, Myles Joyce6, Dara Kavanagh4,5, Paul McCormick4, Seán Martin3, John Burke1,2; Collaborators*
1Department of Surgery, Beaumont Hospital, Dublin, Ireland;
2Royal College of Surgeons Ireland, Dublin, Ireland;
3Centre for Colorectal Disease, St. Vincent’s University Hospital, Dublin, Ireland;
4Department of Surgery, St. James’ Hospital, Dublin, Ireland;
5Department of Surgery, Tallaght University Hospital, Dublin, Ireland;
6Department of Colorectal Surgery, University Hospital Galway, Galway, Ireland;
7Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland;
8Department of Colorectal Surgery, University Hospital Limerick, Limerick, Ireland;
9Department of Surgery, Cork University Hospital, University College Cork, Cork, Ireland;
10Department of Surgery, Mercy University Hospital, Grenville Place, Cork, Ireland;
11Department of General and Colorectal Surgery, University Hospital Waterford, Waterford, Ireland;
12Department of Surgery, James Connolly Memorial Hospital, Dublin, Ireland;
13Department of Surgery, Our Lady of Lourdes Hospital Drogheda, Drogheda, Ireland;
14Department of Surgery, Midland Regional Hospital, Mullingar, Ireland
*Collaborators: Beaumont Hospital: Joseph Deasy, Arnold Hill, Paula Loughlin, Deborah McNamara, Niamh McCawley, Shaheel Sahebally; St. Vincent’s University Hospital: Ann Hanly, Rory Kennelly, Des Winter; St. James’ Hospital: Michael Kelly, John Larkin, Brian Mehigan; Tallaght University Hospital: Paul Neary, James O’Riordan, Maria Whelan; University Hospital Galway: Aisling Hogan, Oliver McAnena, Babk Meshkat, Eddie Myers, Mark Regan; Mater Misericordiae University Hospital: Ann Brannigan, Jürgen Mulsow, Conor Shields; University Hospital Limerick: Nasir Ali, Calvin Coffey, Eoghan Condon, Eamon Kavanagh, Zeb Khan, Shona Tormey, David Waldron; Cork University Hospital: Noel Lynch, Morgan McCourt, Paeder Waters; Mercy University Hospital: Gerard McGreal, Thomas Murphy, Michael O’Riordan, Cristoir O’Suilleabhain, Adrian O’ Sullivan, Aongus Twomey; University Hospital Waterford: Fiachra Cooke, Peter McCullough, Altaher Sheik, Saqib Zeeshan; James Connolly Memorial Hospital: Michael Allen, David Beddy D; Our Lady of Lourdes Hospital: Eleanor Carton, Sherif El-Masry.
Background: Proctectomy is frequently deferred at total abdominal colectomy (TAC) for ulcerative colitis (UC) due to acuity or immunosuppressive treatments leaving patients to choose between delayed proctectomy with or without ileal pouch-anal anastomosis (IPAA), or rectal surveillance.
Methods: This multicentre retrospective analysis assesses outcomes after TAC for UC between 2013–2022. Perioperative and follow-up details were collected. Primary outcome was the fate of the rectum. Secondary outcomes included morbidity, mortality, and length of stay (LoS). Logistic regression analysis was performed.
Results: In total 441 TACs were performed, commonly emergently (69.2%), laparoscopically (71.1%), and with recent steroid (83.5%) or biologic (72%) exposure. Post-operative 30-day morbidity was 42.8% and associated with steroid use [odds ratio (OR) 2.17, P=0.02], age (OR 1.96, P=0.04) and open surgery (OR 2.32, P<0.001). Delayed proctectomy was performed in 232, 41.8% with IPAA. Increasing age (OR 0.99, P=0.05), prolonged hospitalisation (OR 0.96, P=0.004) and open TAC (OR 0.59, P=0.04) reduced likelihood of proctectomy, while biologic use increased it (OR 1.70, P=0.04). Laparoscopic TAC was strongly associated with IPAA (OR 5.74, P=0.006). Of the remaining 209 patients, 69.9% are under follow-up and 51.7% have chosen surveillance. These patients are older (P=0.07), and more likely had an open TAC (P=0.03) with prolonged LoS (P=0.006).
Conclusions: Factors including age, immunosuppressive therapy, and surgical approach influence post-operative morbidity and rectal management. Only 22.2% of patients received an ileoanal pouch after TAC.
Keywords: Ileal pouch-anal anastomosis (IPAA); proctectomy; rectum; total abdominal colectomy (TAC); ulcerative colitis (UC)
