The fate of the rectal stump after subtotal colectomy for ulcerative colitis

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Abstract
In a retrospective review of 311 patients having subtotal colectomy for ulcerative colitis, information on the fate of the rectal stump was obtained in 288. Protectomy was performed in 159 patients (55%); for persistent proctitis in 118 (4%), cancer prophylaxis in 37 (13%), and cancer in 4 (1.4%). Patients, (122, 42%) had ileorectal anastomoses. Of these, 84 (69%) retained a functioning ileorectal anastomosis at the time of follow-up or death, 1-22 yr later, and an additional 6 patients (5%) had a satisfactory ileorectal anastomosis for 5-14 yr before protectomy. Cancer developed in the rectal stump in 9 patients (3.1%), underscoring the need for either proctectomy (total or mucosal) or long-term surveillance of the retained rectum. Subtotal colectomy, by permitting ileorectal anastomosis or other sphincter-preserving surgery at a later date, does have a definite place in many patients requiring surgery for ulcerative colitis.