Appendectomy could reduce relapse rates in patients with ulcerative colitis compared with medical therapy alone, according to recent findings.
The results stemmed from the ACCURE trial, an international study conducted in the Netherlands, Ireland, and the United Kingdom.
In the study, researchers evaluated 197 patients with ulcerative colitis who were in remission but experienced at least one relapse within the previous year. The participants were randomly assigned to undergo either laparoscopic appendectomy plus standard medical therapy or standard medical therapy alone. The primary objective was to determine if appendectomy could lower relapse rates over 1 year.
The patients who underwent appendectomy had significantly fewer relapses, with only 36% experiencing relapses compared with 56% in the medication-only group. This result represented a 35% relative reduction in relapse risk.
"Appendectomy might be an effective and safe option for reducing the relapse rate within 1 year in patients with ulcerative colitis," stated the study authors, members of the ACCURE Study Group.
At the trial's onset, participant demographics were comparable, with an average age of 43 years. Most participants were female and on oral mesalazine as maintenance therapy.
Secondary findings included fewer patients in the appendectomy group requiring biological medications typical escalation in severe ulcerative colitis compared with the medication-only group. By the end of the study, 3.2% of surgical patients had begun biologics compared with 5.5% in the control group. The researchers indicated this might suggest surgery could delay the need for stronger medication.
Quality-of-life measures improved slightly among surgical patients, particularly regarding bowel symptoms assessed by the Inflammatory Bowel Disease Questionnaire (IBDQ). However, overall quality-of-life scores were similar between the groups.
Surgical complications were minimal, with two serious adverse events reported: one patient had internal herniation requiring surgery, and another experienced an intraabdominal hematoma. Both were successfully treated. General side effects occurred equally in both groups.
No colectomies occurred during the study, highlighting appendectomy's potential as a viable maintenance strategy. The researchers emphasized the appendix's possible immunological role in ulcerative colitis, building on earlier observational studies suggesting similar benefits.
A limitation noted by the researchers was the absence of a placebo surgery group, potentially influencing patient perceptions of quality-of-life improvements. Additionally, the prolonged patient enrollment period raised questions about the general applicability of the findings, although the study's international scope helped strengthen its overall validity.
Further research is ongoing to identify patients who could benefit most from appendectomy and to determine whether these benefits persist beyond 1 year.
The authors' disclosures are available in the published study.
