In a recent study published in the Annals for Internal Medicine, a team of researchers from the University of Pennsylvania was able to determine that elective colectomy is associated with improved survival in comparison with to medical therapy among patients aged 50 years or older with advanced Ulcerative Colitis (UC).
“Ulcerative colitis is a chronic disease that most physicians opt to treat with medications, as opposed to surgery,” Meenakshi Bewtra, MD, PhD, MPH,assistant professor of medicine and epidemiology at University of Pennsylvania School of Medicine, said in a press release. “This new finding highlights a potential unrecognized advantage of a surgical approach to the disease.”
In the study titled ”Mortality Associated With Medical Therapy Versus Elective Colectomy in Ulcerative Colitis: A Cohort Study,” the researchers sought to understand if patients with advanced UC that underwent elective colectomy had an improved survival in comparison with those that received treatment with medical therapy. Data was retrieved from Medicare and Medicaid between 2000 and 2011.
The analysis included a total of 830 patients pursuing elective colectomy and 7,541 matched patients pursuing medical therapy. The study primary outcome was time to death.
The results revealed that the rates of mortality associated with elective surgery and medical therapy were 34 and 54 deaths per 1000 person-years, respectively. The researchers also found an association between elective colectomy and an improved survival in comparison with long-term medical therapy.
Further statistical analysis by age group revealed improved survival with surgery in patients that were aged 50 years or older with an advanced stage of UC.
“With this new knowledge, physicians should be empowered to begin a dialogue about surgery earlier in their patients’ course of treatment,” Bewtra said in the news release. “Many patients are afraid of surgical therapy for UC. This study should help them to understand that the benefits of surgery may extend beyond just reducing the symptoms of uncontrolled UC.”
In a related editorial, David B. Sachar, MD, from The Mount Sinai Medical Center in New York City, wrote that the study has “substantial limitations,” including its observational design, the cohort being limited to Medicare and Medicaid patients, that the survival benefit appeared limited to older patients “who may be more susceptible to the hazards of prolonged illness and long-term use of potent immunosuppressants,” and that “the survival benefit of surgery seemed most pronounced when compared with patients treated only with medication that did not include immunomodulating drugs.”
He concluded in the editorial that “despite these shortcomings, the study carries two important messages for gastroenterologists and their patients. First, surgery is associated with a survival benefit, a finding previously suggested by European data. Second, and perhaps more important, we need to reappraise the answer to the question … What constitutes success? … This study demonstrates that simply keeping a patient’s colon intact is not a sufficient long-term measure of therapeutic ‘success.’”
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