The Justification for Prophylactic Surgery

The high cancer risk and dubious prognosis is disquieting and it automatically raises the question as to the advisability of prophylactic excisional surgery. Over the years, the opinion has been sharply divided as to the justification for this step. While some authors consider that the cancer risk does not necessarily justify an increased use of colectomy [13, 14] others advocate preventive surgery for all patients with a 10-year history of ulcerative colitis and total involvement of the colon and rectum [4, 5, 6]. Still others go even further and recommend surgery for all patients with a radiologically abnormal colon four or more years after the onset of disease [15]. However, even in patients with longstanding colitis, elective proctocolectomy, with its inherent mortality and morbidity, cannot be justified on the basis of cancer prevention in patients whose colitis is restricted to the distal half of the colon. However, in the group of patients with total or subtotal involvement of the colon with a colitic history of 10 or more years, a very strong case can clearly be argued for elective surgery on the basis of cancer prevention alone. In such patients, the risk of cancer with continued conservative treatment is so high as to completely outweigh the hazards of prophylactic surgery.

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