Contemporary Risk of Surgery in Patients With Ulcerative Colitis and Crohn's Disease: A Meta-Analysis of Population-Based Cohorts

Lester Tsai, Christopher Ma, Parambir S Dulai, Larry J Prokop, Samuel Eisenstein, Sonia L Ramamoorthy, Brian G Feagan, Vipul Jairath, William J Sandborn, Siddharth Singh, Lester Tsai, Christopher Ma, Parambir S Dulai, Larry J Prokop, Samuel Eisenstein, Sonia L Ramamoorthy, Brian G Feagan, Vipul Jairath, William J Sandborn, Siddharth Singh

Abstract

Background & aims: We conducted a systematic review with meta-analysis to estimate rates and trends of colectomy in patients with ulcerative colitis (UC), and of primary and re-resection in patients with Crohn's disease (CD), focusing on contemporary risks.

Methods: Through a systematic review until September 3, 2019, we identified population-based cohort studies that reported patient-level cumulative risk of surgery in patients with UC and CD. We evaluated overall and contemporary risk (after 2000) of surgery and analyzed time trends through mixed-effects meta-regression.

Results: In patients with UC (26 studies), the overall 1-, 5-, and 10-year risks of colectomy was 4.0% (95% CI, 3.3-5.0), 8.8% (95% CI, 7.7-10.0), and 13.3% (95% CI, 11.3-15.5), respectively, with a decrease in risk over time (P < .001). Corresponding contemporary risks were 2.8% (95% CI, 2.0-3.9), 7.0% (95% CI, 5.7-8.6), and 9.6% (95% CI, 6.3-14.2), respectively. In patients with CD (22 studies), the overall 1-, 5-, and 10-year risk of surgery was 18.7% (95% CI, 15.0-23.0), 28.0% (95% CI, 24.0-32.4), and 39.5% (95% CI, 33.3-46.2), respectively, with a decrease in risk over time (P < .001). Corresponding contemporary risks were 12.3% (95% CI, 10.8-14.0), 18.0% (95% CI, 15.4-21.0), and 26.2% (95% CI, 23.4-29.4), respectively. In a meta-analysis of 8 studies in patients with CD with prior resection, the cumulative risk of a second resection at 5 and 10 years after the first resection was 17.7% (95% CI, 13.5-22.9) and 31.3% (95% CI, 24.1-39.6), respectively.

Conclusions: Patient-level risks of surgery have decreased significantly over time, with a 5-year cumulative risk of surgery of 7.0% in UC and 18.0% in CD in contemporary cohorts. This decrease may be related to early detection and/or better treatment.

Keywords: Disease Modification; Inflammatory Bowel Diseases; Natural History; Resection; Tumor Necrosis Factor.

Copyright © 2021. Published by Elsevier Inc.

Figures

Figure 1.
Figure 1.
Cumulative risk of colectomy in patients with ulcerative colitis by (A) 1-year, (B) 5-years and (C) 10-years after diagnosis. Studies are arranged in order of mid-year of cohort recruitment.
Figure 2.
Figure 2.
Cumulative risk of major abdominal surgery in patients with Crohn’s disease by (A) 1-year, (B) 5-years and (C) 10-years after diagnosis. Studies are arranged in order of mid-year of cohort recruitment.
Figure 3.
Figure 3.
Cumulative risk of re-resection in patients with Crohn’s disease with prior surgery by (A) 5-years and (B) 10-years after first surgery. Studies are arranged in order of mid-year of cohort recruitment.

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