Elective colectomy seems to improve survival vs. medical therapy for UC
Among ulcerative colitis patients aged 50 years and older, elective colectomy appeared to be associated with a reduced risk for death compared with long-term medical therapy in a recent study.
“Ulcerative colitis is a chronic disease that most physicians opt to treat with medications, as opposed to surgery,” Meenakshi Bewtra, MD, PhD, MPH, assistant professor of medicine and epidemiology at University of Pennsylvania School of Medicine, said in a press release. “This new finding highlights a potential unrecognized advantage of a surgical approach to the disease.”
Aiming to determine whether patients with advanced UC have improved survival with elective colectomy vs. long-term medical therapy, Bewtra and colleagues used U.S. Medicare and Medicaid data from 2000 to 2011 to perform a retrospective matched cohort study. Overall, 830 patients pursuing elective colectomy and 7,541 matched patients pursuing medical therapy were included, and the primary outcome was time to death.
The researchers found the mortality rate associated with elective colectomy was 34 deaths per 1,000 person-years (95% CI; 26-44), while the mortality rate associated with medical therapy was 54 deaths per 1,000 person-years (95% CI, 50-57). Elective colectomy was associated with improved survival compared with long-term medical therapy (adjusted HR = 0.67; 95% CI, 0.52-0.87), but this was not statistically significant in all sensitivity analyses. Post hoc analysis showed patients aged 50 years or older with advanced UC had improved survival with elective colectomy compared with patients aged younger than 50 years (HR = 0.6; 95% CI, 0.45-0.79).
“With this new knowledge, physicians should be empowered to begin a dialogue about surgery earlier in their patients’ course of treatment,” Bewtra said. “Many patients are afraid of surgical therapy for UC. This study should help them to understand that the benefits of surgery may extend beyond just reducing the symptoms of uncontrolled UC.”
In a related editorial, David B. Sachar, MD, from The Mount Sinai Medical Center in New York City, wrote that the study has “substantial limitations,” including its observational design, the cohort being limited to Medicare and Medicaid patients, that the survival benefit appeared limited to older patients “who may be more susceptible to the hazards of prolonged illness and long-term use of potent immunosuppressants,” and that “the survival benefit of surgery seemed most pronounced when compared with patients treated only with medication that did not include immunomodulating drugs.”
He concluded that “despite these shortcomings, the study carries two important messages for gastroenterologists and their patients. First, surgery is associated with a survival benefit, a finding previously suggested by European data. Second, and perhaps more important, we need to reappraise the answer to the question … What constitutes success? … This study demonstrates that simply keeping a patient’s colon intact is not a sufficient long-term measure of therapeutic ‘success.’” – by Adam Leitenberger
Disclosures: Bewtra reports a grant from the NIH during the conduct of the study and speaking engagements for Imedex and the Crohn’s & Colitis Foundation of America/Robert Michael Educational Institute outside the submitted work. Please see the full study for a list of all other authors’ relevant financial disclosures. Sachar reports no relevant financial disclosures.