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Derks ME, Te Groen M, Peters CP, Dijkstra G, de Vries AC, Romkens TE, Horjus CS, de Boer NK, Bemelman WA, Nagtegaal ID, Derikx LA, Hoentjen F. Endoscopic and surgical treatment outcomes of colitis-associated advanced colorectal neoplasia: a multicenter cohort study. Int J Surg 2023; Publish Ahead of Print:01279778-990000000-00436. [PMID: 37300890 PMCID: PMC10389479 DOI: 10.1097/js9.0000000000000335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/05/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) patients are at increased risk of advanced neoplasia (high-grade dysplasia (HGD) or colorectal cancer (CRC)). We aimed to (1) assess synchronous and metachronous neoplasia following (sub)total or proctocolectomy, partial colectomy or endoscopic resection for advanced neoplasia in IBD and (2) identify factors associated with treatment choice. MATERIAL AND METHODS In this retrospective multicenter cohort study, we used the Dutch nationwide pathology databank (PALGA) to identify patients diagnosed with IBD and colonic AN between 1991 and 2020 in seven hospitals in the Netherlands. Logistic and Fine&Gray's subdistribution hazard models were used to assess adjusted subdistribution hazard ratios (asHR) for metachronous neoplasia and associations with treatment choice. RESULTS We included 189 patients (HGD n=81; CRC n=108). Patients were treated with proctocolectomy (n=33), (sub)total colectomy (n=45), partial colectomy (n=56) and endoscopic resection (n=38). Partial colectomy was more frequently performed in patients with limited disease and older age, with similar patient characteristics between Crohn's disease and ulcerative colitis. Synchronous neoplasia was found in 43 patients (25.0%; (sub)total or proctocolectomy n=22, partial colectomy n=8, endoscopic resection n=13). We found a metachronous neoplasia rate of 6.1, 11.5 and 13.7 per 100 patient-years after (sub)total colectomy, partial colectomy and endoscopic resection, respectively. Endoscopic resection, but not partial colectomy, was associated with an increased metachronous neoplasia risk (asHR 4.16, 95% CI 1.64-10.54, P<0.01) compared to (sub)total colectomy. CONCLUSION After confounder adjustment, partial colectomy yielded a similar metachronous neoplasia risk compared to (sub)total colectomy. High metachronous neoplasia rates after endoscopic resection underline the importance of strict subsequent endoscopic surveillance.
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Affiliation(s)
- Monica Ew Derks
- Inflammatory Bowel Disease Center, Department of Gastroenterology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Maarten Te Groen
- Inflammatory Bowel Disease Center, Department of Gastroenterology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Charlotte P Peters
- Department of Gastroenterology, Amsterdam University Medical Center, location AMC, Amsterdam, The Netherlands
| | - Gerard Dijkstra
- Department of Gastroenterology, Groningen University Medical Center, University of Groningen, Groningen, The Netherlands
| | - Annemarie C de Vries
- Department of Gastroenterology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Tessa Eh Romkens
- Department of Gastroenterology, Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | - Carmen S Horjus
- Department of Gastroenterology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Nanne Kh de Boer
- Department of Gastroenterology and Hepatology, AGEM Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Willem A Bemelman
- Department of Surgery, Amsterdam University Medical Center, location AMC, Amsterdam, The Netherlands
| | - Iris D Nagtegaal
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lauranne Aap Derikx
- Inflammatory Bowel Disease Center, Department of Gastroenterology, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Gastroenterology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Frank Hoentjen
- Inflammatory Bowel Disease Center, Department of Gastroenterology, Radboud University Medical Centre, Nijmegen, The Netherlands
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Canada
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