In the past, the indication for prophylactic colectomy for patients with longstanding ulcerative colitis was mainly based on the disease history and the clinical risk factors mentioned above. Today, with the availability of colonoscopy and the recognition of the dys-plasia-precancer-cancer sequence, surveillance colonoscopy with serial colonoscopic examinations and mucosal biopsies is thought to allow for a more adequate individual assessment of the cancer risk and firm recommendation for surgery before the development of cancer. Thus, it is stated that prophylactic surgery should be reserved for patients whose biopsy findings are indicative of heightened cancer risk based on the joint interpretation by the clinician and the pathologist.
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