P104 Systematic review: oncological outcomes of patients with inflammatory bowel disease undergoing segmental colonic resections for colorectal cancer and dysplasia

Introduction

International guidelines recommend proctocolectomy in IBD patients with high grade dysplasia or colorectal cancer, and to consider it in cases of low grade or indeterminate dysplasia. However, segmental colectomy (including subtotal/total colectomy) is considered by some as a valid alternative. This systematic review aims to assess outcomes of segmental colectomy versus proctocolectomy for IBD patients with dysplasia and cancer.

Methods

Studies published between 1990 and 2022 reporting on oncological and surgical outcomes of adults undergoing segmental resection and/or proctocolectomy that included at least three cases of neoplasia were included. Descriptive statistics were used in the context of significant heterogeneity.

Results

The search returned 2,223 studies, and 8 were included in the final analysis comprising 4,124 patients: 3,753 segmental resections and 371 proctocolectomies. The significant heterogeneity and paucity of the data limited any statistical analysis, and it was not possible to calculate definitive rates of missed synchronous neoplasia, metachronous neoplasia, completion surgery, colitis relapse or overall survival. However, the data suggests that overall survival is not influenced by type of surgery. No studies reported quality of life outcomes.

Conclusions

The paucity of data highlights need for prospective studies to evaluate the outcomes following segmental resection for cancer and dysplasia to better inform discussions with patients. Although the incidence of metachronous CRC and dysplasia recurrence is obviously higher than in proctocolectomy, overall survival is not affected. If offering this option, the emphasis on long-term implications, including future need for surgery and strict adherence to lifelong endoscopic surveillance of the remnant colon or rectum is crucial.