TY - JOUR
T1 - New insights on the surgical management of ulcerative colitis in the 21st century
AU - Kotze, Paulo G.
AU - Heuthorst, Lianne
AU - Lightner, Amy L.
AU - Damião, Aderson O. M. C.
AU - Bemelman, Willem A.
N1 - Funding Information: PGK received research funding from Takeda and Pfizer; serves as a consultant for Takeda, Pfizer, AbbVie, and Janssen; and has received speakers fees from Takeda, Pfizer, AbbVie, and Janssen. LH has no conflicts of interests. ALL serves as a consultant for Takeda and Ossium Health, and participates on the advisory board of TRACT therapeutics. AOMCD serves as a consultant for Takeda, AbbVie, and Ferring; has received speakers fees from Takeda, Janssen, AbbVie, and Pfizer; has received support for attending meetings for Takeda and Janssen; and participates on the advisory board of Takeda. WAB received research funding from VIFOR; served as a consultant for Takeda and Braun; and received speakers fees from Takeda, Johnson, Braun, and Medtronic. Publisher Copyright: © 2022 Elsevier Ltd
PY - 2022/7/1
Y1 - 2022/7/1
N2 - Despite substantial advances in medical therapy since 2005 that have led to the approval and increased use of novel biological agents and small molecules, colectomy is still a therapeutic option for some patients with ulcerative colitis. In the biological era (ie, after the approval of biological agents for ulcerative colitis), improved control of disease activity has led to a trend of decreasing colectomy rates for refractory disease. Consequently, indications for colectomy for dysplasia and colorectal cancer seem to be increasing. Advances have not only been made in surgical techniques, but also in multidisciplinary approaches, the timing of surgery, and in medical management before and after surgery. This Review discusses surgical indications in patients with ulcerative colitis in relation to current medical therapy, management in the acute setting, indications for staged procedures, new techniques such as transanal surgery and robotics, and surgical alternatives to ileal pouch–anal anastomosis. A multidisciplinary approach including surgeons, gastroenterologists, pathologists, radiologists, and clinical nutritionists is essential to improving patient outcomes in different clinical scenarios of ulcerative colitis management in the 21st century.
AB - Despite substantial advances in medical therapy since 2005 that have led to the approval and increased use of novel biological agents and small molecules, colectomy is still a therapeutic option for some patients with ulcerative colitis. In the biological era (ie, after the approval of biological agents for ulcerative colitis), improved control of disease activity has led to a trend of decreasing colectomy rates for refractory disease. Consequently, indications for colectomy for dysplasia and colorectal cancer seem to be increasing. Advances have not only been made in surgical techniques, but also in multidisciplinary approaches, the timing of surgery, and in medical management before and after surgery. This Review discusses surgical indications in patients with ulcerative colitis in relation to current medical therapy, management in the acute setting, indications for staged procedures, new techniques such as transanal surgery and robotics, and surgical alternatives to ileal pouch–anal anastomosis. A multidisciplinary approach including surgeons, gastroenterologists, pathologists, radiologists, and clinical nutritionists is essential to improving patient outcomes in different clinical scenarios of ulcerative colitis management in the 21st century.
UR - http://www.scopus.com/inward/record.url?scp=85131810815&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/S2468-1253(22)00001-2
DO - https://doi.org/10.1016/S2468-1253(22)00001-2
M3 - Review article
C2 - 35364005
SN - 2468-1253
VL - 7
SP - 679
EP - 688
JO - lancet. Gastroenterology & hepatology
JF - lancet. Gastroenterology & hepatology
IS - 7
ER -