TY - JOUR
T1 - Pouch functional outcomes after restorative proctocolectomy with ileal-pouch reconstruction in patients with ulcerative colitis
T2 - Japanese multi-center nationwide cohort study
AU - On Behalf Of A Research Grant On Intractable Disease Affiliated With The Japan Ministry Of Health Labor Welfare
AU - Uchino, Motoi
AU - Ikeuchi, Hiroki
AU - Sugita, Akira
AU - Futami, Kitaro
AU - Watanabe, Toshiaki
AU - Fukushima, Kouhei
AU - Tatsumi, Kenji
AU - Koganei, Kazutaka
AU - Kimura, Hideaki
AU - Hata, Keisuke
AU - Takahashi, Kenichi
AU - Watanabe, Kazuhiro
AU - Mizushima, Tsunekazu
AU - Funayama, Yuji
AU - Higashi, Daijiro
AU - Araki, Toshimitsu
AU - Kusunoki, Masato
AU - Ueda, Takeshi
AU - Koyama, Fumikazu
AU - Itabashi, Michio
AU - Nezu, Riichiro
AU - Suzuki, Yasuo
N1 - Funding Information:
This work was supported in part by Health and Labor Science Research Grants for research on intractable diseases from the Ministry of Health, Labor and Welfare of Japan. M. Itabashi received an honorarium from Bayer Yakuhin, Ltd., and a research grant from Takeda Parmaceutical Co. and Chugai Pharmaceutical Co., Ltd. T. Watanabe received a research grant from Mitsubishi Tanabe Pharm. Y. Suzuki received an honorarium from Mitsubishi Tanabe Pharma Corp., ZERIA Pnarmaceutical Co., Ltd., and AbbVie GK., Eisai Co., Ltd., KYORIN Pharmaceutical Co., Ltd.
Funding Information:
Acknowledgements This work was supported in part by Health and Labor Science Research Grants for research on intractable diseases from the Ministry of Health, Labor and Welfare of Japan. M. Itabashi received an honorarium from Bayer Yakuhin, Ltd., and a research grant from Takeda Parmaceutical Co. and Chugai Pharmaceutical Co., Ltd. T. Watanabe received a research grant from Mitsubishi Tanabe Pharm. Y. Suzuki received an honorarium from Mitsubishi Tanabe Pharma Corp., ZERIA Pnarmaceutical Co., Ltd., and AbbVie GK., Eisai Co., Ltd., KYORIN Pharmaceutical Co., Ltd.
Publisher Copyright:
© 2017, Japanese Society of Gastroenterology.
PY - 2018/5/1
Y1 - 2018/5/1
N2 - Background: Although several complications capable of causing pouch failure may develop after restorative proctocolectomy (RPC) for ulcerative colitis (UC), the incidences and causes are conflicting and vary according to country, race and institution. To avoid pouch failure, this study aimed to evaluate the rate of pouch failure and its risk factors in UC patients over the past decade via a nationwide cohort study. Methods: We conducted a retrospective, observational, multicenter study that included 13 institutions in Japan. Patients who underwent RPC between January 2005 and December 2014 were included. The characteristics and backgrounds of the patients before and during surgery and their postoperative courses and complications were reviewed. Results: A total of 2376 patients were evaluated over 6.7 ± 3.5 years of follow-up. Twenty-seven non-functional pouches were observed, and the functional pouch rate was 98.9% after RPC. Anastomotic leakage (odds ratio, 9.1) was selected as a risk factor for a non-functional pouch. The cumulative pouch failure rate was 4.2%/10 years. A change in diagnosis to Crohn’s disease/indeterminate colitis (hazard ratio, 13.2) was identified as an independent risk factor for pouch failure. Conclusion: The significant risk factor for a non-functional pouch was anastomotic leakage. The optimal staged surgical procedure should be selected according to a patient’s condition to avoid anastomotic failure during RPC. Changes in diagnosis after RPC confer a substantial risk of pouch failure. Additional cohort studies are needed to obtain an understanding of the long-standing clinical course of and proper treatment for pouch failure.
AB - Background: Although several complications capable of causing pouch failure may develop after restorative proctocolectomy (RPC) for ulcerative colitis (UC), the incidences and causes are conflicting and vary according to country, race and institution. To avoid pouch failure, this study aimed to evaluate the rate of pouch failure and its risk factors in UC patients over the past decade via a nationwide cohort study. Methods: We conducted a retrospective, observational, multicenter study that included 13 institutions in Japan. Patients who underwent RPC between January 2005 and December 2014 were included. The characteristics and backgrounds of the patients before and during surgery and their postoperative courses and complications were reviewed. Results: A total of 2376 patients were evaluated over 6.7 ± 3.5 years of follow-up. Twenty-seven non-functional pouches were observed, and the functional pouch rate was 98.9% after RPC. Anastomotic leakage (odds ratio, 9.1) was selected as a risk factor for a non-functional pouch. The cumulative pouch failure rate was 4.2%/10 years. A change in diagnosis to Crohn’s disease/indeterminate colitis (hazard ratio, 13.2) was identified as an independent risk factor for pouch failure. Conclusion: The significant risk factor for a non-functional pouch was anastomotic leakage. The optimal staged surgical procedure should be selected according to a patient’s condition to avoid anastomotic failure during RPC. Changes in diagnosis after RPC confer a substantial risk of pouch failure. Additional cohort studies are needed to obtain an understanding of the long-standing clinical course of and proper treatment for pouch failure.
KW - Crohn’s disease
KW - Functional pouch
KW - Ileal pouch-anal anastomosis
KW - Indeterminate colitis
KW - Pouch failure
KW - Restorative proctocolectomy
KW - Ulcerative colitis
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U2 - 10.1007/s00535-017-1389-z
DO - 10.1007/s00535-017-1389-z
M3 - Article
C2 - 28884201
AN - SCOPUS:85028981993
VL - 53
SP - 642
EP - 651
JO - Journal of Gastroenterology
JF - Journal of Gastroenterology
SN - 0944-1174
IS - 5
ER -