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ARTICLE TYPE : RESEARCH ARTICLE

Published on :   03 Dec 2025, Volume - 1
Journal Title :   WebLog Journal of Gastroenterology | WebLog J Gastroenterol
Source URL:   weblog iconhttps://weblogoa.com/articles/wjg.2025.l0302
Permanent Identifier (DOI) :  doi iconhttps://doi.org/10.5281/zenodo.17864185

Colorectal Cancer Risk in Ulcerative Colitis Patients With and Without Colectomy: A Propensity-Matched Cohort Study

Rawan Elkomi 2 *
Syed Fahad Gillani 2
Daniel Larbi 2
Jesse Maynard 1
Rana Elkomi 2
Syed Asad Geelani 4
Elizabeth Beyene 2
Miriam Michael 2,3
1College of Medicine, Howard University, Washington, DC, USA
2Department of Internal Medicine, Howard University, Washington, DC, USA
3Department of Internal Medicine, University of Maryland School of Medicine, Baltimore, USA
4Deaprtment of Gastroenterology, University Hospitals of Leicester, Leicester, United Kingdom

Abstract

Background & Aims: The long-term risk of colorectal neoplasia in ulcerative colitis (UC) patients undergoing colectomy remains poorly quantified. This study compared the incidence of colorectal malignancies in UC patients with versus without colectomy across 5-year, 10-year, and 20-year follow-up.

Methods: Using the TriNetX US Collaborative Network, we conducted a propensity score-matched cohort study of 3,767 UC patients with colectomy (partial/total) and 3,767 non-colectomy UC controls, matched for age, sex, race, and family cancer history. Outcomes included incident colon (C18), rectosigmoid (C19), and rectal (C20) cancers analyzed at 5-year, 10-year, and 20-year intervals. Risk ratios (RR), hazard ratios (HR), and survival probabilities were calculated.

Results: Colectomy patients had significantly higher risks of colorectal cancers. Colon cancer incidence was 20.0% at 5 years (vs. 1.6%, HR 13.2), persisting through 10 and 20 years. Rectosigmoid cancer risk peaked at 5 years (HR 20.4), remaining elevated at 20 years (HR 14.4). Rectal cancer risk was consistently increased (HR range 7.4–8.3). 20-year survival was significantly lower in colectomy patients.

Conclusions: Colectomy for UC is associated with a markedly increased risk of colorectal malignancy, particularly in the first 5 years for colon cancer and persistently for rectosigmoid and rectal cancers. Lifelong surveillance is warranted post-colectomy.

Keywords: Ulcerative Colitis; Colectomy: Colorectal Cancer; Inflammatory Bowel Disease; Cancer Surveillance

Citation

Elkomi R, Gillani SF, Larbi D, Maynard J, Elkomi R, Geelani SA, et al. Colorectal Cancer Risk in Ulcerative Colitis Patients With and Without Colectomy: A Propensity-Matched Cohort Study. WebLog J Gastroenterol. wjg.2025.l0302. https://doi.org/10.5281/zenodo.17864185
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