Proctocolectomy with ileostomy vs other colectomy in PSC-UC

What is known

• The reduced risk with permanent ileostomy was mainly driven by fewer LTs or deaths from liver failure (HR 0.24, 95% CI 0.10–0.53). ¹
• Survival differed significantly between proctocolectomy with ileostomy and proctocolectomy with pouch (p=0.003) and between ileostomy and subtotal/hemicolectomy (p=0.04). ¹
• In a colectomy-only sensitivity analysis, proctocolectomy with pouch carried significantly higher risk than proctocolectomy with ileostomy (HR 2.01, 95% CI 1.04–3.88), with no significant effect of surgical indication. ¹
• Findings are interpreted as supporting a gut–liver axis role in PSC pathophysiology, warranting consideration in counselling before colorectal surgery. ¹

What is unknown / caveats

• Registry/observational design. Cannot establish that the surgical choice itself causes the survival difference
• The excerpts do not address surgical morbidity, quality of life, or other harms that also inform the choice of operation
• Older sources note ileostomy-specific complications (e.g., peristomal varices, ileostomy hemorrhage) as references only, not quantified here
• The association is from observational registry data and does not prove the procedure choice causally reduces LT or death.

References

1. Mol B, van Nieuwamerongen M, van Munster KN, Färkkilä M, Folseraas T, Tjønnfjord SKV, Hov JR, Boberg K, Vesterhus M, Jørgensen KK, Bergquist A, Goet JC, de Vries AC, van der Meer AJP, Weersma RK, Inderson A, Bogaards JA, Ponsioen CY, IPSCR study G. Proctocolectomy with permanent ileostomy is associated with improved transplant-free survival in patients with PSC. JHEP Rep. 2026. PMID: 41757378.

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