Segmental colectomy versus total proctocolectomy for ulcerative colitis: A systematic review and meta-analysis.

Aim: Total proctocolectomy (TPC) is the standard of care for patients with ulcerative colitis (UC) and dysplasia not amenable to endoscopic management. However, the risks of an extensive resection may outweigh the benefits in high-risk surgical patients. Therefore, we performed a systematic review and meta-analysis to assess postoperative outcomes between segmental colectomy (SEG) versus TPC in patients with UC.

Study Design: Global databases were searched from inception until August 2022 for comparative studies reporting the postoperative outcomes of patients with UC undergoing SEG versus TPC. The primary outcomes were subsequent neoplasia development and overall survival. Odds ratios (ORs), hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs) were calculated. The Newcastle-Ottawa Scale and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) were used for quality-of-evidence assessment.

Results: Eight retrospective studies comprising 4856 patients were included. Overall, 1620 (33%) patients underwent SEG. SEG patients were older, had more comorbidities and mostly underwent right colectomy (40%) and sigmoidectomy (16%). Most studies included UC patients and concomitant colorectal cancer. Reoperation and Clavien-Dindo III-IV odds were equivalent (OR 3.17; 95% CI 0.12, 81.25; I 66%; OR 0.79; 95% CI 0.48, 1.31; I 74%). There was no difference in neoplasia development (OR 5.05, 95% CI 0.37, 68.66; I 61%) nor in overall survival (HR 1.20, 95% CI 0.73, 1.97; I 61%). The risk of bias was high in all included studies and the quality of evidence was low.

Conclusion: Low-quality evidence failed to demonstrate any discernible differences in the postoperative outcomes between SEG and TPC. However, given the limited granularity of the analysed data and the high likelihood of imprecise results, we cannot assert that SEG and TPC are equivalent. Furthermore, there was a suggestion of an elevated risk of neoplasia development and inferior overall survival in the SEG group.