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Has widespread use of biologic and immunosuppressant therapy for ulcerative colitis affected surgical trends? Results of a questionnaire survey of surgical institutions in Japan

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Abstract

Purpose

The aim of the study is to assess the relationship between the introduction of biologic and immunosuppressant therapy and the number of patients undergoing surgery for ulcerative colitis (UC).

Methods

A questionnaire survey about patients undergoing surgery for UC was sent to 26 teaching hospitals throughout Japan. The questionnaire period spanned from 2008 to 2013, to account for the introduction of tacrolimus (2009) and infliximab (2010).

Results

The total number of patients who underwent surgery was 297, 291, 273, 255, 300, and 305 in 2008, 2009, 2010, 2011 2012, and 2013, respectively. The emergency surgery rate remained stable at 32–34 % each year. The proportion of patients who underwent surgery for cancer increased from 13.8 % in 2008 to 20 % in 2013. In 2013, 41, 38, and 6 % of patients who underwent surgery had received treatment with a biologic, tacrolimus, and cyclosporine, respectively. No institution reported an increase in postoperative complications among patients treated with immunosuppressive drugs.

Conclusions

The number of patients undergoing surgery decreased temporarily soon after infliximab and tacrolimus first became widely available, but subsequently increased again. The emergency surgery rate remained unchanged throughout the study period. These data show that immunosuppressive drugs have had little effect on the risk of postoperative complications.

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Acknowledgments

We thank Dr. Singo Kameoka of Tokyo Women’s Medical University, Dr. Iwao Sasaki of Miyagi Kenshin Plaza, Dr. Katsuyoshi Hatakeyama of Niigata University, Dr. Tsuneo Iiai of Shirone Kensei Hospital, Dr. Michio Itabashi of Tokyo Women’s Medical University, Dr. Hiroki Ohge of Hiroshima University, Dr. Masato Kusunoki of Mie University, Dr. Toru Kono of Sapporo Higashi Tokushukai Hospital, Dr. Hirohiko Sato of Tokushima University, Dr. Rikisaburo Sahara of Tokyo Yamate Medical Center, Dr. Akira Sugita of Yokohama Municipal Citizen’s Hospital, Dr. Toshio Nakamura of Fujieda Municipal General Hospital, Dr. Kohei Fukushima of Tohoku University, Dr. Hisao Fujii of Nara Medical University, Dr. Yuji Funayama of Sendai Red Cross Hospital, Dr. Koutaro Maeda of Fujita Health University, and Dr. Takayuki Yamamoto of Yokkaichi Hazu Medical Center for their co-operation in the IBD Surgical Forum. We also thank Dr. Ken Takeuchi, a gastroenterologist at Toho University Sakura Medical Center, for his comments on medical therapies for UC.

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Authors and Affiliations

  1. Inflammatory Bowel Disease Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Kanagawa, Japan

    Hideaki Kimura

  2. Department of Colorectal Surgery, Tohoku Rosai Hospital, Sendai, Miyagi, Japan

    Kenichi Takahashi

  3. Department of Surgery, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan

    Kitaro Futami

  4. Inflammatory Bowel Disease Center, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan

    Hiroki Ikeuchi

  5. Inflammatory Bowel Disease Center, Yokohama Municipal Citizen’s Hospital, Yokohama, Kanagawa, Japan

    Kenji Tatsumi

  6. Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan

    Kazuhiro Watanabe

  7. Department of Surgical Oncology, Osaka City University School of Medicine, Osaka, Japan

    Kiyoshi Maeda

  8. Department of Surgery, Hiroshima University, Hiroshima, Japan

    Yusuke Watadani

  9. Department of Surgery, Nishinomiya Municipal Central Hospital, Nishinomiya, Hyogo, Japan

    Riichiro Nezu

  10. Division of Digestive and General Surgery, Niigata University, Niigata, Japan

    Hitoshi Kameyama

  11. Second Department of Surgery, Tokyo Women’s Medical University, Tokyo, Japan

    Sayumi Nakao

  12. Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan

    Kiyotaka Kurachi

  13. Department of Surgery, Junwakai Memorial Hospital, Miyazaki, Japan

    Masayuki Hotokezaka

  14. Department of Surgery, Iwate Medical University School of Medicine, Morioka, Iwate, Japan

    Koki Otsuka

  15. Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan

    Toshiaki Watanabe

  16. Division of Colorectal Surgery, Tochigi Cancer Center, Utsunomiya, Tochigi, Japan

    Heita Ozawa

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  1. Hideaki Kimura
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  2. Kenichi Takahashi
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  3. Kitaro Futami
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  4. Hiroki Ikeuchi
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  5. Kenji Tatsumi
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  8. Yusuke Watadani
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  9. Riichiro Nezu
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  11. Sayumi Nakao
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  13. Masayuki Hotokezaka
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  15. Toshiaki Watanabe
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  16. Heita Ozawa
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Corresponding author

Correspondence to Hideaki Kimura.

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We have no conflicts of interest to declare for this study.

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Kimura, H., Takahashi, K., Futami, K. et al. Has widespread use of biologic and immunosuppressant therapy for ulcerative colitis affected surgical trends? Results of a questionnaire survey of surgical institutions in Japan. Surg Today 46, 930–938 (2016). https://doi.org/10.1007/s00595-015-1259-3

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  • DOI: https://doi.org/10.1007/s00595-015-1259-3

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