S0753 Children With a History of UC and IPAA Experience a More Rapid Progression to Pouch Failure Compared With Adults and Historical Controls

Abstract

INTRODUCTION: Though there are significant differences in surgical outcomes between pediatric and adult ulcerative colitis (UC) patients undergoing colectomy1–3, counseling families on outcomes has largely been guided by data from adult cohorts. We compared differences in pouch survival between pediatric and adult patients undergoing total proctocolectomy with ileal-pouch anal-anastomosis (IPAA). METHODS: This is a retrospective single-center study of inflammatory bowel disease (IBD) patients treated with IPAA who subsequently underwent pouchoscopy at the University of Chicago Medical Center between 1980 and 2019. Data were collected for 426 subjects via electronic medical records. We stratified the study population based on age at UC diagnosis or age at IPAA using a cutoff of 19 years. Differences between groups were assessed using t-tests and Chi-square tests. Kaplan Meier curves were used to compare survival probabilities. RESULTS: We identified 111 patients diagnosed with UC before age 19 and 53 patients undergoing IPAA before age 19 (Table 1). Pouch failure in pediatric patients occurred twice as often compared with adult patients (18.3% vs 9.7%, P = 0.1). Pediatric IPAA patients were more likely to require anti-TNF post-colectomy (41.5%) compared to adult patients (25.8%, P < 0.05) and to pediatric counterparts who had surgery in adulthood (22.1%, P = 0.05). Analysis by decade of IPAA surgery revealed that children undergoing IPAA in the 1990s and 2000s had survival estimates above 75% until 12- and 25-years post-colectomy. However, for IPAA performed since 2010, this threshold remains only five-years post-colectomy (P < 0.001) (Figure 1). Comparing pediatric and adult patients with stratification by pre-operative anti-TNF exposure, we observe that pediatric IPAA patients receiving anti-TNF therapies pre-colectomy had the most rapid progression to pouch failure (P = 0.027) (Figure 2). CONCLUSION: There are lower rates of pouch survival for children with UC undergoing IPAA in the anti-TNF era compared to both historical pediatric controls and contemporary adults. While more work is needed to understand the mechanistic underpinnings associated with these findings, anticipatory guidance for pediatric patient families prior to surgery and plans for surveillance after should reflect these outcomes.Table 1.: Study Population Stratified by Age at IPAA (n = 383)Figure 1.: Kaplan Meier Pouch Survival Estimate for Pediatric Patients based on Decade of IPAA.Figure 2.: Kaplan Meier Pouch Survival Estimate for Adult and Pediatric Patients based on Anti-TNF Exposure Prior to IPAA.