title: Has widespread use of biologic and immunosuppressant therapy for ulcerative colitis affected surgical trends? Results of a questionnaire survey of surgical institutions in Japan.
abstract: OBJECTIVE
  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.
authors.affiliation: Inflammatory Bowel Disease Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Kanagawa, Japan. hkim@yokohama-cu.ac.jp.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Kimura
authors.affiliation: Department of Colorectal Surgery, Tohoku Rosai Hospital, Sendai, Miyagi, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Takahashi
authors.affiliation: Department of Surgery, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan.
authors.forename: Kitaro
authors.initials: K
authors.lastname: Futami
authors.affiliation: Inflammatory Bowel Disease Center, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Ikeuchi
authors.affiliation: Inflammatory Bowel Disease Center, Yokohama Municipal Citizen's Hospital, Yokohama, Kanagawa, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Tatsumi
authors.affiliation: Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Watanabe
authors.affiliation: Department of Surgical Oncology, Osaka City University School of Medicine, Osaka, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Maeda
authors.affiliation: Department of Surgery, Hiroshima University, Hiroshima, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Watadani
authors.affiliation: Department of Surgery, Nishinomiya Municipal Central Hospital, Nishinomiya, Hyogo, Japan.
authors.forename: Riichiro
authors.initials: R
authors.lastname: Nezu
authors.affiliation: Division of Digestive and General Surgery, Niigata University, Niigata, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Kameyama
authors.affiliation: Second Department of Surgery, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Sayumi
authors.initials: S
authors.lastname: Nakao
authors.affiliation: Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Kurachi
authors.affiliation: Department of Surgery, Junwakai Memorial Hospital, Miyazaki, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Hotokezaka
authors.affiliation: Department of Surgery, Iwate Medical University School of Medicine, Morioka, Iwate, Japan.
authors.forename: Koki
authors.initials: K
authors.lastname: Otsuka
authors.affiliation: Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Watanabe
authors.affiliation: Division of Colorectal Surgery, Tochigi Cancer Center, Utsunomiya, Tochigi, Japan.
authors.forename: Heita
authors.initials: H
authors.lastname: Ozawa
mesh_terms: D001685:Biological Factors / Q000627:therapeutic use*; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000601:surgery*; D016572:Cyclosporine / Q000627:therapeutic use; D013505:Digestive System Surgical Procedures / Q000706:statistics & numerical data* / Q000639:trends*; D006784:Hospitals, Teaching / Q000706:statistics & numerical data*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D000069285:Infliximab / Q000627:therapeutic use; D007564:Japan; D011183:Postoperative Complications / Q000453:epidemiology; D012306:Risk; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D016559:Tacrolimus / Q000627:therapeutic use; D013997:Time Factors
chemical_list: D001685:Biological Factors; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D000069285:Infliximab; D016559:Tacrolimus
keywords: Biologics; Immunosuppressants; Surgery; Ulcerative colitis