Macaluso FS, et al. - After systemically searching PubMed Central/Medline and Embase for records published between January 2000 and December 2017, researchers assessed patients with chronic refractory ulcerative colitis (UC) for risk factors for colectomy in the biologic era. Investigators found several factors to be related to a higher or reduced risk for colectomy, including variables at baseline (progression from proctitis/left-sided to extensive colitis, extensive colitis at diagnosis, high baseline C-reactive protein or erythrocyte sedimentation rate, male gender, and younger age at diagnosis), previous medical history, and factors arising during therapy with biologics, including the absence of clinical response after induction with infliximab or adalimumab, and the lack of mucosal healing during therapy with anti-TNFs. A first risk stratification attained by analyzing factors at baseline and medical history (including the prior exposure to anti-TNFs) or the early assessment (after 12-16 weeks of treatment) of clinical and endoscopic response is a strong predictor of the subsequent risk of colectomy during therapy with biologics. These two points may help doctors decide when the surgical option can be considered in patients with chronic refractory UC.