Do outcomes differ after 3-Stage versus 2-Stage Ileal Pouch-Anal Anastomosis for chronic Ulcerative Colitis?
Notice bibliographique
Résumé
Given concerns of increased post-operative complications associated with anti-TNF-alpha antibody therapy, some surgeons are increasingly offering patients with chronic ulcerative colitis (CUC) a 3-stage approach to ileal pouch-anal anastomosis (IPAA). We aimed to assess outcomes after the 1st of 2-stages compared with the 2nd of 3-stages in a cohort of patients who underwent hand-assisted laparoscopic surgery (HALS). We identified all adult patients with CUC who underwent total proctocolectomy (TPC-IPAA, stage 1 of 2) and patients who underwent completion proctectomy (CP-IPAA, stage 2 of 3) at our institution from 2004 - 2009 using a prospectively maintained database. Univariate analysis assessed differences in 30-day outcomes after stage 1 of 2 as compared with stage 2 of 3. Data are frequency (proportion) or median. Over 5-years, 243 patients underwent HALS restorative proctocolectomy: TPC-IPAA (n= 212, 88%) or CP-IPAA (n= 30, 12%). At time of IPAA, patients in these two groups were not significantly different with respect to age, gender, BMI, medical comorbidities, and ASA classification. Two cases in TPC-IPAA had concurrent cancer, while none in the CP-IPAA did (p= 0.47). TPC-IPAA patients were less likely to have had prior abdominal (21% vs. 100%, p<0.0001) or intestinal surgery (1.4% vs. 100%, p<0.0001) compared to CP-IPAA. In regards to colitis medications, TPC-IPAA were more likely to be receiving 5-ASA (59% vs. 17%, p<0.0001), corticosteroids (75% vs. 23%, P<0.0001) or Immunomodulators (37% vs. 3.3%, p<0.0001); 13% of the TPCIPAA group, and none of the CP-IPAA group were receiving biologic therapy (p= 0.0006). In terms of severity of disease, according to the Montreal classification, TPC-IPAA had more severe disease than CP-IPAA (p<0.0001), while 23% and 13% were recently hospitalized (p= 0.2), 8% and 10% were recently transfused (p= 0.7), 12.8% and 30% were malnourished (p= 0.02), and 78.8% and 6.7% were had recently received either corticosteroids or biologic therapy (p<0.0001). In terms of surgical outcomes, 16 (7.5%) of TPC-IPAA were converted to laparotomy (most commonly for obesity, n= 4). Intra-operative complications occurred in TPC-IPAA was 8 (3.8%, most commonly for bleeding, n= 7), and after CP-IPAA none (0%, p= 0.14). TPC-IPAA had longer operative times (291 vs. 187, p<0.0001), and similar lengths of stay (5 vs. 5 days, p= 0.83) and readmissions (15.5% vs. 16.7%, p= 0.87). A total of 8% had re-operation after TPC-IPAA, and none after CP-IPAA (p= 0.03). Overall complications of any grade occurred in similar proportions (38% and 43%, p= 0.58). There were a total of 6 (2.8%) anastomotic leaks after TPC-IPAA, and none after CP-IPAA (p= 0.2). There were no mortalities in either group. Ileal pouch-anal anastomosis at the time of completion proctectomy, as compared with total proctocolectomy, is associated with shorter operative times, fewer intra-operative complications and reoperations, with similar rates of readmissions and overall complications. Further study in a larger cohort is needed to determine if a 3-stage approach to IPAA is associated with a lower anastomotic leak rate - the most important determinant of long-term pouch function and patient quality of life.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».