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©The Author(s) 2023.
World J Gastrointest Oncol. Aug 15, 2023; 15(8): 1317-1331
Published online Aug 15, 2023. doi: 10.4251/wjgo.v15.i8.1317
Published online Aug 15, 2023. doi: 10.4251/wjgo.v15.i8.1317
Table 2 Summary of guidelines and consensus statements reporting on surgical management in inflammatory bowel disease
Society | Disease type | Absolute indication (surgery is recommended) | Relative indication (surgery can be considered) |
ACG, 2019; guideline[51] | UC | Dysplasia in UC is not resectable or is multifocal | Moderately to severely active UC who are refractory or intolerant to medical therapy |
ACG, 2018; guideline[56] | CD | No statements are provided | Intra-abdominal abscess |
AGA, 2021; expert consensus[52] | IBD | Unresectable visible dysplasia or invisible multifocal or high-grade dysplasia on histology | No statements are provided |
AOCC and APAG, 2021; expert consensus[57] | IBD | No statements are provided | |
BSG, 2019; guideline[58] | UC | Patients with acute severe UC who have not responded within 7 d of rescue therapy with infliximab or ciclosporin, or those with deterioration or complications before that time (including toxic megacolon, severe hemorrhage or perforation): Subtotal colectomy and ileostomy, with preservation of the rectum; patients who have chronic active symptoms despite optimal medical therapy: Surgical resection of the colon and rectum | |
CD | Localized ileocaecal CD for those failing or relapsing after initial medical therapy, or in those preferring surgery to the continuation of drug therapy: Lparoscopic resection; patients with small bowel CD strictures shorter than 10 cm: Strictureplasty/resection; patients with severe perianal CD refractory to medical therapy: Fecal stream diversion | ||
ASCRS, 2020[71]; guideline | CD | Patients with severe acute colitis who do not adequately respond to medical therapy or who have signs or symptoms of impending or actual perforation; patients with a free perforation: surgical resection of the perforated segment | Patients who demonstrate an inadequate response to, develop complications from or are nonadherent with medical therapy; patients with symptomatic small-bowel or anastomotic strictures that are not amenable to medical therapy and/or endoscopic dilation; patients with strictures of the colon that cannot be adequately surveyed endoscopically: Resection; patients with penetrating Crohn’s disease with abscess formation; patients with enteric fistulas that persist despite appropriate medical therapy |
CSG 2018; Chinese consensus[53] | UC | Massive hemorrhage, perforation, malignancy, and high suspicion of malignant pathology | Severe UC that is refractory to active medical treatment, and toxic megacolon refractory to medical treatment should; undergo surgical intervention early; poor efficacy of medical treatment and/or adverse drug reactions that have seriously affected patients’ quality of life |
CD | CD complications1, ineffective medical treatment2 | No statements are provided | |
ECCO, 2019; guideline[70] | UC | No statements are provided | Refractory and corticosteroid-dependent patients; patients with UC and a minimally affected rectum |
ECCO, 2020; guideline[72] | CD | Patients with refractory pancolonic Crohn’s disease without a history of perianal disease: Restorative proctocolectomy with IPAA; patients with a single involved colonic segment in CD: Segmental colectomy; patients with limited, nonstructuring, ileocaecal CD (diseased terminal ileum < 40 cm): Laparoscopic resection; Small-bowel strictures related to CD: Strictureplasty; patients with short (< 5 cm) strictures of the terminal ileum in CD: Endoscopic balloon dilatation or surgery; patients with CD and complex perianal fistulae: Ligation of the intersphincteric fistula tract | |
JSG, 2020; guideline[62] | IBD | In severe cases of IBD and those with cancer or dysplasia; patients with symptoms caused by the primary disease that do not improve with medical treatment, side effects of medication, and extraintestinal complications (especially pyoderma gangrenosum) | |
WGO, 2015; guideline[54] | UC | Medical treatment is not completely successful or in the presence of dysplasia | |
CD | Surgery should be considered as an alternative to medical treatment early in the disease course for short-segment CD limited to the distal ileum |
- Citation: Dan WY, Zhou GZ, Peng LH, Pan F. Update and latest advances in mechanisms and management of colitis-associated colorectal cancer. World J Gastrointest Oncol 2023; 15(8): 1317-1331
- URL: https://www.wjgnet.com/1948-5204/full/v15/i8/1317.htm
- DOI: https://dx.doi.org/10.4251/wjgo.v15.i8.1317