SECRET-IBD: results of a multicentre retrospective observational cohort study on oncological outcome of selected patients with inflammatory bowel disease who have undergone partial and subtotal colorectal resections

Objective Population-based studies have demonstrated that partial resections (PR), including subtotal colorectal resections, are performed in 40–70% of patients with inflammatory bowel disease (IBD)-associated colorectal cancer (CRC). Data on their outcomes are scarce. Our aim is to compare oncological and postoperative outcomes between PR and proctocolectomy (PC) in IBD centres in England. Methods Data of all adult patients with IBD undergoing colorectal resections in 2004–2019 for dysplasia and CRC were collected from three centres. Descriptive statistics, survival, univariable and multivariable analyses were applied. Results Of 131 patients identified, 43 underwent PR and 88 PC. There were more patients with Crohn’s disease, primary sclerosing cholangitis and advanced stage cancer in the PR cohort, while PC had more extensive colitis and multifocal neoplasia. Median follow-up was 90 months (range 11–204) and 89 months (range 0.5–211), respectively. Synchronous cancer in a segment different from the original neoplasia was found in 9/131 (7%). Metachronous cancer was found in 1/43 (2%) at 10 years in the PR cohort. Five of 43 (12%) had completion surgery for dysplasia. The PC cohort had significantly higher stoma rates (65% vs 93%, p<0.001). No significant difference in overall survival was observed between PR and PC (85% vs 93% at 5 years (p=0.684)). Conclusions The study suggests comparable oncological outcome between partial including subtotal colorectal resection and PC in selected patients with IBD-associated neoplasia. Stoma avoidance may be achieved with PR but at the cost of future colitis flares, surveillance and completion surgery. The findings are consistent with the published literature and collectively can be used to inform the shared decision-making process around extent of resection in carefully selected patients.