Update and latest advances in mechanisms and management of colitis-associated colorectal cancer

Table 2 Summary of guidelines and consensus statements reporting on surgical management in inflammatory bowel disease

Society	Disease type	Absolute indication (surgery is recommended)	Relative indication (surgery can be considered)
ACG, 2019; guideline[51]	UC	Dysplasia in UC is not resectable or is multifocal	Moderately to severely active UC who are refractory or intolerant to medical therapy
ACG, 2018; guideline[56]	CD	No statements are provided	Intra-abdominal abscess
AGA, 2021; expert consensus[52]	IBD	Unresectable visible dysplasia or invisible multifocal or high-grade dysplasia on histology	No statements are provided
AOCC and APAG, 2021; expert consensus[57]	IBD	No statements are provided
BSG, 2019; guideline[58]	UC	Patients with acute severe UC who have not responded within 7 d of rescue therapy with infliximab or ciclosporin, or those with deterioration or complications before that time (including toxic megacolon, severe hemorrhage or perforation): Subtotal colectomy and ileostomy, with preservation of the rectum; patients who have chronic active symptoms despite optimal medical therapy: Surgical resection of the colon and rectum
	CD	Localized ileocaecal CD for those failing or relapsing after initial medical therapy, or in those preferring surgery to the continuation of drug therapy: Lparoscopic resection; patients with small bowel CD strictures shorter than 10 cm: Strictureplasty/resection; patients with severe perianal CD refractory to medical therapy: Fecal stream diversion
ASCRS, 2020[71]; guideline	CD	Patients with severe acute colitis who do not adequately respond to medical therapy or who have signs or symptoms of impending or actual perforation; patients with a free perforation: surgical resection of the perforated segment	Patients who demonstrate an inadequate response to, develop complications from or are nonadherent with medical therapy; patients with symptomatic small-bowel or anastomotic strictures that are not amenable to medical therapy and/or endoscopic dilation; patients with strictures of the colon that cannot be adequately surveyed endoscopically: Resection; patients with penetrating Crohn’s disease with abscess formation; patients with enteric fistulas that persist despite appropriate medical therapy
CSG 2018; Chinese consensus[53]	UC	Massive hemorrhage, perforation, malignancy, and high suspicion of malignant pathology	Severe UC that is refractory to active medical treatment, and toxic megacolon refractory to medical treatment should; undergo surgical intervention early; poor efficacy of medical treatment and/or adverse drug reactions that have seriously affected patients’ quality of life
	CD	CD complications1, ineffective medical treatment2	No statements are provided
ECCO, 2019; guideline[70]	UC	No statements are provided	Refractory and corticosteroid-dependent patients; patients with UC and a minimally affected rectum
ECCO, 2020; guideline[72]	CD	Patients with refractory pancolonic Crohn’s disease without a history of perianal disease: Restorative proctocolectomy with IPAA; patients with a single involved colonic segment in CD: Segmental colectomy; patients with limited, nonstructuring, ileocaecal CD (diseased terminal ileum < 40 cm): Laparoscopic resection; Small-bowel strictures related to CD: Strictureplasty; patients with short (< 5 cm) strictures of the terminal ileum in CD: Endoscopic balloon dilatation or surgery; patients with CD and complex perianal fistulae: Ligation of the intersphincteric fistula tract
JSG, 2020; guideline[62]	IBD	In severe cases of IBD and those with cancer or dysplasia; patients with symptoms caused by the primary disease that do not improve with medical treatment, side effects of medication, and extraintestinal complications (especially pyoderma gangrenosum)
WGO, 2015; guideline[54]	UC	Medical treatment is not completely successful or in the presence of dysplasia
	CD	Surgery should be considered as an alternative to medical treatment early in the disease course for short-segment CD limited to the distal ileum

¹Intestinal obstruction, abdominal abscess, fistula formation, acute perforation, major bleeding, carcinogenesis.

²Severe Crohn’s disease refractory to steroid therapy; patients with poor efficacy of medical treatment and/or adverse drug reactions that have seriously affected the quality of life.

IPAA: Ileal pouch-anal anastomosis; UC: Ulcerative colitis; IBD: Inflammatory bowel disease; CD: Crohn’s disease; ACG: American College of Gastroenterology; AGA: American Gastroenterological Association; AOCC: Asian Organization for Crohn’s and Colitis; BSG: British Society of Gastroenterology; CSG: Chinese Society of Gastroenterology; ECCO: European Crohn’s and Colitis Organization; JSG: Japanese Society of Gastroenterology; WGO: World Gastroenterology Organization.