Difference in the Prognostic Benefit Between Extended and Segmental Colectomy for Patients With Neoplasia Associated With Ulcerative Colitis: A Nationwide Multicenter Study

BACKGROUND: Extended colectomy is considered standard treatment for neoplasia associated with ulcerative colitis, but there is limited supporting evidence, particularly from large-scale studies. OBJECTIVE: This study aimed to assess the prognostic benefits of extended colectomy in patients with neoplasia associated with ulcerative colitis using a nationwide database. DESIGN: Multicenter retrospective study. SETTINGS: Forty-three institutions in Japan participated in this study. PATIENTS: Patients with ulcerative colitis diagnosed with intestinal neoplasia between 1983 and 2020 at 43 institutions were analyzed. MAIN OUTCOME MEASURES: Five-year overall survival and disease-free survival were assessed based on different surgical procedures, with a subgroup analysis comparing neoplasia associated with ulcerative colitis to sporadic cancer. RESULTS: Among 879 patients, 801 were diagnosed with neoplasia associated with ulcerative colitis and 78 with sporadic cancer. The 5-year disease-free survival for total proctocolectomy and subtotal colectomy were similar (87.8% and 83.9%), both superior to segmental colectomy (72.0%). When comparing neoplasia associated with ulcerative colitis to sporadic cancer, extended colectomy (total proctocolectomy and subtotal colectomy) showed significantly better outcomes for neoplasia associated with ulcerative colitis, while no significant difference was observed for sporadic cancer. Multivariable analysis revealed a significantly better prognosis for extended colectomy compared to segmental colectomy in neoplasia associated with ulcerative colitis patients, both in overall survival and disease-free survival ( P < 0.001). LIMITATION: Nonrandomized retrospective study design. CONCLUSION: This nationwide cohort study supports extended colectomy as the gold standard for neoplasia associated with ulcerative colitis management and underscores the importance of accurate diagnosis to distinguish between neoplasia associated with ulcerative colitis and sporadic cancer for optimal treatment decisions. See Video Abstract.