Long-term functional outcomes and quality of life after restorative proctocolectomy and ileal pouch-anal anastomosis

Česká verzia

Authors: M. Kostrejová ¹; M. Bortlík ^2,3; D. Ďuricová ^2,4 ; M. Kolář ² ; R. Sequens ^5,6; M. Lukáš ^2,7
Authors place of work: Gastroenterologie a digestivní endoskopie, Nemocnice Milosrdných sester sv. Karla Boromejského v Praze ¹; Klinické a výzkumné centrum pro střevní záněty, ISCARE I. V. F. a. s., Praha ²; Interní klinika 1. LF UK a ÚVN Praha ³; Farmakologický ústav, 1. LF UK a VFN v Praze ⁴; Chirurgické oddělení, NH Hospital a. s., Nemocnice Hořovice ⁵; Chirurgické oddělení, Nemocnice Milosrdných sester sv. Karla Boromejského v Praze ⁶; Ústav lékařské biochemie a laboratorní diagnostiky, 1. LF UK a VFN v Praze ⁷
Published in the journal: Gastroent Hepatol 2016; 70(1): 38-44
Category: Original Article
doi: https://doi.org/10.14735/amgh201638

Summary

Introduction:
Restorative proctocolectomy with ileal pouch anal anastomosis has become a surgical procedure of choice in patients with ulcerative colitis.

Aims and Methods:
The aim of this study was to assess long-term functional results and quality of life in ulcerative colitis (n = 138) patients who underwent ileal pouch anal anastomosis between 1993 and 2013 in two Czech refferal centers.

Results:
A total of 118 (85.5%) out of 138 patients answered all of the questions in the questionnaires, 62% of whom were male. Median age at proctocolectomy was 34 (18–56) years and the median follow-up time was 7.9 (2.1–20.7) years. The overall late complication rate was 29.2%. Pouch failure occurred in 7.9% patients, and pouch excision was required in two patients (1.6%). In 8.7% and 10.2% of patients, respectively, anastomotic strictures and complete fistula were detected. The “re-do” pelvic pouch procedure was applied to 5.5% of patients and 24% developed at least one episode of acute pouchitis, and 15% of patients suffered from chronic pouchitis. The median score of functional outcome was 2 (0–19), according to the Wexner Continence Score. The median number of bowel movements during the daytime was 6 (1–15), 2 at night (0–7), and 8 in 24 hours (2–20). Impairments in health-related quality of life were mainly in psychological and social areas and to a lesser degree in the physical area. The scores of Physical Component Summary and Mental Component Summary were significantly lower than those of the general population (p < 0.001).

Conclusion:
The majority of patients were fully continent; however, one third had a slightly lower quality of life than the general population, and had worse functional outcomes. This should be taken into account during the selection process for the best treatment alternative.

Key words:
ulcerative colitis – quality of life – restorative proctocolectomy – ileal pouch-anal anastomosis

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

Submitted:
26. 1. 2016

Accepted:
8. 2. 2016

Zdroje

1. Lukáš M. Současnost a budoucnost v léčbě ulcerózní kolitidy. Gastroent Hepatol 2013; 67(3): 212– 218.

2. Bach SP, Mortensen NJ. Revolution and evolution: 30 years of ileoanal pouch surgery. Inflamm Bowel Dis 2006; 12(2): 131– 145.

3. Lovegrove RE, Heriot AG, Constantinides V et al. Meta-analysis of shortterm outcomes of J, W and S ileal reservoirs for restorative proctocolectomy. Colorectal Dis 2007; 9(4): 310– 320.

4. Fazio VW, O’Riordain MG, Lavery IC et al. Long-term functional outcome and quality of life after stapled restorative proctocolectomy. Ann Surg 1999; 230(4): 575– 584. doi: 10.1097/ 00000658-199910000-0.

5. Thirlby RC, Sobrino MA, Randall JB. The long-term benefit of surgery on health-related quality of life in patients with inflammatory bowel disease. Arch Surg 2001; 136(5): 521– 527.

6. Michelassi F, Lee J, Rubin M. Long-term functional results after ileal pouch anal restorative proctocolectomy for ulcerative colitis: a prospective observational study. Ann Surg 2003; 238(3): 433– 441.

7. Scarpa M, Angriman I, Ruffolo C et al. Health-related quality of life after restorative proctocolectomy for ulcerative colitis: long-term results. World J Surg 2004; 28(2): 124– 129.

8. Wuthrich P, Gervaz P , Ambrosetti P. Functional outcome and quality of life after restorative proctocolectomy and ileo-anal pouch anastomosis. Swiss Med Wkly 2009; 139(13– 14): 193– 197. doi: smw-12355.

9. Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey. I. Conceptual framework and item selection. Med Care 1999; 30(6): 473– 483.

10. Sobotík Z. Zkušenosti s použitím předběžné české verze amerického dotazníku o zdraví (SF-36). Zdravotnictví v České republice 1998: (1– 2): 50– 54.

11. Petr P. Regionální standard Kvality života podmíněné zdravím. Kontakt 2001; 3(3): 146– 150.

12. Brazier JE, Harper R, Jones NM et al. Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ 1992; 305(6846): 160– 164.

13. Sansoni J, Hawthorne G, Fleming G et al. The revised faecal incontinence scale: a clinical validation of a new, short measure for assessment and outcomes evaluation. Dis Colon Rectum 2013; 56(5): 652– 659. doi: 10.1097/ DCR.0b013e318279c2ac.

14. Vaizey CJ, Carapeti E, Cahill JA. Prospective comparison of faecal incontinence grading systems. Gut 1999; 44(1): 77– 80.

15. R Core Team (2014). R: A Language and Environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. [online]. Available from: www.r-project.org.

16. Richardson D, deMontbrun S, Johnson PM.Surgical management of ulcerative colitis: a comparison of Canadian and American colorectal surgeons. Can J Surg 2011; 54(4): 257– 262. doi: 10.1503/ cjs.001610.

17. Cohen JL, Strong SA, Hyman NH. Practice parameters for the surgical treatment of ulcerative colitis. Dis Colon Rectum2005; 48(11): 1997– 2009.

18. Grucela A, Steinhagen RM. Current surgical management of ulcerative colitis. Mt Sinai J Med 2009; 76(6): 606– 612. doi: 10.1002/ msj.20152.

19. Bortlík M, Ďuricová D, Kohout P et al. Doporučení pro podávání biologické terapie u idiopatických střevních zánětů: 2. vydání. Gastroent Hepatol 2012; 66(1): 12– 22.

20. Travis SP, Stange EF, Lémann M et al.European evidence-based Consensus on the management of ulcerative colitis: Current management. J of Crohns Colitis 2008; 2(1): 24– 26. doi: 10.1016/ j.crohns.2007.11.002.

21. Hicks CW, Hodin RA, Bordeianou L. Possible overuse of 3-stage procedures for active ulcerative colitis. JAMA Surg 2013; 148(7): 658– 664. doi: 10.1001/ 2013.jamasurg.325.

22. Fleming FJ, Francone TD, Kim MJ et al.A laparoscopic approach does reduce short-term complications in patients undergoing ileal pouch-anal anastomosis. Dis Colon Rectum 2011; 54(2): 176– 182. doi: 10.1007/ DCR.0b013e3181fb4232.

23. Ahmed Ali U, Keus F, Heikens JT et al.Open versus laparoscopic (assisted) ileo pouch anal anastomosis for ulcerative colitis and familial adenomatous polyposis. Cochrane Database Syst Rev 2009; 21(1): CD006267. doi: 10.1002/ 14651858.CD006267.pub2.

24. Fazio VW, Kiran RP, Remzi FH et al. Ileal pouch anal anastomosis: analysis of outcome and quality of life in 3707 patients. Ann Surg 2013; 257(4): 679– 685 doi: 10.1097/ SLA.0b013e31827d99a2.

25. de Zeeuw S, Ahmed Ali U, Donders RA.Update of complications and functional outcome of the ileo-pouch anal anastomosis: overview of evidence and meta-analysis of 96 observational studies. Int J Colorectal Dis 2012; 27(7): 843– 853. doi: 10.1007/ s00384-011-1402-6.

26. Berndtsson IE, Carlsson EK, Persson EIet al. Long-term adjustment to living with an ileal pouch-anal anastomosis. Dis Colon Rectum 2011; 54(2): 193– 199. doi: 10.1007/ DCR.0b013e3181ff42d8.

27. Wuthrich P, Gervaz P, Ambrosetti P et al. Functional outcome and quality of life after restorative proctocolectomy and ileo-anal pouch anastomosis. Swiss Med Wkly 2009; 139(13– 14): 193– 197. doi: smw-12355.

28. Andersson T, Lunde OC, Johnson E et al. Long-term functional outcome and quality of life after restorative proctocolectomy with ileo-anal anastomosis for colitis. Colorectal Dis 2011; 13(4): 431– 437. doi: 10.1111/ j.1463-1318.2009.02163.x.

29. Brown C, Gibson PR, Hart A et al. Long-term outcomes of colectomy surgery among patients with ulcerative colitis. Springerplus 2015; 4(1): 573. doi: 10.1186/ s40064-015-1350-7. eCollection 2015.

30. Burisch J, Weimers P, Pedersen N. Health-related quality of life improves during one year of medical and surgical treatment in a European population-based inception cohort of patients with inflammatory bowel disease – an ECCO-EpiCom study. J Crohns Colitis 2014; 8(9): 1030– 1042. doi: 10.1016/ j.crohns.2014.01.028.