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

Area of Science:

• Gastroenterology
• Surgical Oncology
• Colorectal Surgery

Background:

• Total proctocolectomy (TPC) is standard for ulcerative colitis (UC) with dysplasia.
• High-risk surgical patients may not benefit from extensive TPC.
• Segmental colectomy (SEG) offers a less extensive alternative.

Purpose of the Study:

• To systematically review and meta-analyze postoperative outcomes comparing SEG versus TPC in UC patients.
• To assess the equivalence of SEG and TPC regarding subsequent neoplasia and overall survival.

Main Methods:

• Systematic review and meta-analysis of eight retrospective studies (4856 patients).
• Searched global databases from inception to August 2022.
• Calculated Odds Ratios (ORs) and Hazard Ratios (HRs); assessed quality using Newcastle-Ottawa Scale and GRADE.

Main Results:

• No significant differences in reoperation, Clavien-Dindo III-IV complications, neoplasia development, or overall survival between SEG and TPC.
• SEG patients were older with more comorbidities.
• High risk of bias and low quality of evidence across included studies.

Conclusions:

• Low-quality evidence suggests no discernible postoperative outcome differences between SEG and TPC.
• Limited data granularity and imprecise results preclude asserting equivalence.
• A potential suggestion of elevated neoplasia risk and inferior survival in the SEG group warrants further investigation.