Global 
Deutschland Colon to Rectum
J Crohns Colitis. 2025;19(2):jjaf015
The impact of advanced medical therapies on time to resection and colorectal cancer outcomes in ulcerative colitis patients undergoing colectomy
Background: The aim of this study was to evaluate the impact of advanced medical therapies (biologicals and small molecules) on time to colectomy and oncological outcomes in ulcerative colitis (UC).
Methods: This cohort study included UC patients who underwent colectomy between 2003 and 2022 at 2 referral centers in Belgium and the Netherlands. Exposure was the use of advanced medical therapies. Primary outcomes were time to colectomy and colorectal cancer (CRC) rate, compared between 4 periods: P1 (2003–2007), P2 (2008–2012), P3 (2013–2017), and P4 (2018–2022). Secondary outcomes were oncological outcomes, including incidental cancers found unexpectedly in resection specimens or during endoscopic follow-up for medication switch.
Results: Among 716 patients, the usage of advanced therapies increased from 36.8% in P1 to 89.7% in P4 (p < 0.0001). Median time to colectomy remained comparable (P1: 7.1 years [interquartile ranges {IQR}, 2.8–12.9] vs. P4: 7.2 years [IQR, 2.7–14.6]; p = not significant). Colectomy and colorectal cancer was diagnosed in 72 patients (10.1%), with no significant change over time (p = 0.44). Proportion of CRC was lower in patients treated with advanced therapies (4.7% vs. 23.6%, p < 0.0001) and related to a shorter follow-up (median 6.1 vs. 10.3 years, p < 0.0001). Advanced therapy patients had higher incidental cancer rates (37.5% vs. 8.3%, p = 0.002), which was associated with reduced CRC-related survival (hazard ratio for CRC-related death: 3.3, 95% confidence interval: 1.17–9.4; p = 0.02).
Conclusion: Despite increased usage of advanced medical therapies, time to resection and colorectal cancer (CRC) rates have remained unchanged in ulcerative colitis patients undergoing colectomy over the past 2 decades. Advanced therapy patients had higher incidental cancers rates, associated with decreased CRC survival. Awareness of timely colectomy is crucial for this group.