title: Surgical approach to ulcerative colitis: when is the best timing after medical treatment?
abstract: Ulcerative colitis (UC) is a chronic inflammatory condition of the mucosa affecting the rectum and extending up the colon in a continuous manner. Its etiology is unknown, but is most probably the result of the interaction of genetic and environmental factors. Approximately 30% of UC patients will need to undergo surgery at some point during their lifetime, despite progresses made in medical therapies. Indications for surgery include acute severe colitis with its complications, steroid-or antiTNF-refractory colitis (or growth impairment in children), and the onset of colorectal dysplasia/cancer. Recently, the introduction of biologic agents has provided a rationale for prolonging medical therapy before considering surgery in the treatment of active, moderate to severe colitis. When surgery becomes indicated, especially in the urgent setting, it usually involves dealing with immunosuppressive medications, possibly impacting the onset of post-operative septic complications. In both acute and chronic settings, patients should be informed about the medical and surgical options and their respective prognoses; the crucial decision regarding the timing for surgery should be shared by both gastroenterologists and colorectal surgeons. The aim of the present review is to highlight surgical indications and options for UC patients as well as the evidence about surgical complications following medical therapies, in order to aid clinicians in determining the best timing for surgery.
authors.affiliation: Third General Surgery Unit, Istituto Clinico Humanitas IRCCS, Università degli Studi di Milano, via Manzoni 56, 20089, Rozzano Milan, Italy. antonino.spinelli@humanitas.it
authors.forename: Antonino
authors.initials: A
authors.lastname: Spinelli
authors.forename: Gianluca M
authors.initials: GM
authors.lastname: Sampietro
authors.forename: Piero
authors.initials: P
authors.lastname: Bazzi
authors.forename: Matteo
authors.initials: M
authors.lastname: Sacchi
authors.forename: Marco
authors.initials: M
authors.lastname: Montorsi
mesh_terms: D001688:Biological Products / Q000627:therapeutic use; D003093:Colitis, Ulcerative / Q000188:drug therapy / Q000601:surgery*; D018450:Disease Progression; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D013997:Time Factors
chemical_list: D001688:Biological Products; D007166:Immunosuppressive Agents