One-year stoma-free survival of ileoanal pouches for UC in European centers: The MIRACLE project.

OBJECTIVE AND

BACKGROUND

Restorative proctocolectomy with ileal pouch-anal anastomosis is the standard surgical procedure for patients with refractory ulcerative colitis. The aim of this study was to evaluate intermediate-term stoma-free rates after ileoanal pouch surgery and current practice in various European centers.

METHODS

In this multicenter retrospective cohort study, we included patients ≥18 years with ulcerative colitis or unclassified inflammatory bowel disease undergoing primary ileoanal pouch construction between 2016 and 2021 in 4 high-volume (>10 pouch procedures annually) and 2 low-volume European centers. The primary outcome was an intermediate-term stoma-free rate (absence of ileostomy > 1-year postpouch). Secondary outcomes included perioperative practice, predictive factors for intermediate-term stoma-free status, and anastomotic leakage management.

RESULTS

In total, 411 patients were included [43% female, median age 40.0 years (IQR, 29.0-52.0)]. Intermediate-term stoma-free rate was 92.2% (378/410 patients), with a variance of 13.0% between centers (P = 0.045). The majority were modified 2-stage (55.5%) or 3-stage (34.5%) procedures. Close rectal dissection (CRD) was performed in 64.6% and transanal minimally invasive surgery proctectomy in 71.8%. Predictive factors for intermediate-term stoma-free status were CRD [odds ratio (OR) = 3.0; 95% confidence interval (CI) = 1.4-6.4; P = 0.01], and high-volume center (OR = 3.7; 95% CI = 1.1-12.5; P = 0.03). In the 56 (13.6%) patients with anastomotic leakage, early diagnosis, and treatment (≤21 days postpouch) were associated with intermediate-term stoma-free status (95.5% vs 41.7%; P < 0.001).

CONCLUSIONS

This study showed that >90% of ileoanal pouch patients are stoma-free more than 1 year after surgery with substantial variance between centers. Centralization of pouch procedures, implementation of CRD proctectomy, and early diagnosis and treatment of anastomotic leakages could further improve results.