The ulcerative rectocolitis is a chronic inflammatory bowel disease that affects the colon and rectum, not affecting the remaining intestinal traits. Surgery is also one of the therapeutic options for its treatment. What are the benefits of surgery? We asked Professor Antonino Spinelli, head of the Operational Unit of Colorectal Surgery at Humanitas and Professor at Humanitas University.
The mucosa covering the affected sections is characterized by ulcerative lesions. The course of the pathology sees the alternation of remission phases and relapse phases. In order to control the symptoms and activity of the disease, the first line of treatment is given by medical therapy, which today has numerous drugs – anti-inflammatory, immunosuppressive and biological – but in some cases it is necessary to resort to surgery.
What type of “patient” should be surgically treated?
The patient who is referred to surgery is often young, with a disease that no longer responds to medication. The pathology is exacerbated and its symptoms affect the quality of life, sometimes in a very significant way,” says the professor.
Patients who respond exclusively to steroid medication treatment may also be referred to surgery. In fact, this type of therapy, not being free from serious side effects, cannot be administered excessively long and therefore it may be necessary to intervene surgically”.
A third group – continues Professor Spinelli – is represented by patients with few symptoms, or in any case well controllable with the therapy. However, these patients develop pre-neoplastic or neoplastic alterations to endoscopic controls. They also need surgery to remove the site of possible tumor development, often very aggressive”.
Medical therapy and surgery
In the treatment of rectocolitis, is it better to attempt surgery as late as possible, in the light of the evolution of the disease? Medical therapy is the first line of action except for those cases with a blazing onset, fortunately not frequent. However, medical therapies may not always be able to control the disease and, when protracted for a long time with poor efficacy, may compromise the patient’s clinical condition, exponentially increasing the risk of post-operative infections and reducing recovery capacity.
“Surgery should therefore be regarded as a weapon available to doctors not as an alternative but in conjunction with medical therapies. In this way, – Professor Spinelli emphasizes – the patient can face the pathology in better conditions, with less risk and with reduced debilitating disorders with which patients often live for years if the therapies do not have the desired effect”.
What are the benefits of surgery? “Surgery is curative and, if performed in high volume reference centers and therefore experienced staff, allows a rapid recovery and restoration of a satisfactory quality of life. Surgery also eliminates the need for chronic medication, with all side effects and risks from taking these therapies. The removal of the colon and rectum also eliminates the risk of neoplastic degeneration, especially in patients with a long history of disease,” concludes Professor Spinelli.
