Colectomy in patients with acute colitis: a systematic review

Area of Science:

• Gastroenterology
• Surgical Oncology
• Clinical Medicine

Background:

• Colectomy for severe acute colitis presents challenges in surgical timing and approach.
• Optimizing perioperative management is crucial for improving patient outcomes.

Purpose of the Study:

• To systematically review early mortality and morbidity associated with colectomy for severe acute colitis.
• To identify areas for improvement in perioperative treatment and patient outcomes.

Main Methods:

• Systematic review of Medline and PubMed databases (1975-2007).
• Inclusion of studies with good methodological quality.
• Separate analysis of laparoscopic colectomy for acute colitis.

Main Results:

• 2,714 patients analyzed; 1,257 underwent urgent/emergency colectomy.
• In-hospital mortality was 8.0%, 30-day mortality was 5.2%, and morbidity was 50.8%.
• Indications shifted from toxic megacolon to refractory acute colitis; mortality decreased from 10.0% to 1.8%, while morbidity remained high (>40%). Laparoscopic colectomy showed 0.6% mortality.

Conclusions:

• Colectomy for acute colitis is associated with significant morbidity.
• While outcomes have improved over three decades, further enhancements are necessary.
• Study limitations include retrospective data and potential selection bias, impacting conclusions on surgical approaches.