Short‐term outcomes of surgical treatment for primary ileocaecal Crohn's disease: Results of the Crohn's(urg) study, a multicentre, retrospective, comparative analysis between inflammatory and complicated phenotypes-Reference-Cited by-同舟云学术

Short‐term outcomes of surgical treatment for primary ileocaecal Crohn's disease: Results of the Crohn's(urg) study, a multicentre, retrospective, comparative analysis between inflammatory and complicated phenotypes

Published:2024-06-10 Issue:7 Volume:26 Page:1415-1427
ISSN:1462-8910
Container-title:Colorectal Disease
language:en
Short-container-title:Colorectal Disease

Author:

Avellaneda Nicolas¹²^ORCID,Pellino Gianluca³⁴^ORCID,Maroli Annalisa⁵⁶,Tottrup Anders¹,Bislenghi Gabriele⁷^ORCID,Colpaert Jan⁷^ORCID,D'Hoore Andre⁷,Carvello Michele⁵⁶,Giorgi Lorenzo⁵,Juachon Patrizia⁵,Harsløf Sanne¹^ORCID,de Buck Van Overstraeten Anthony⁸,Olivera Pablo A.⁹¹⁰¹¹,Gomez Javier⁸,Holubar Stefan D.¹²^ORCID,Naranjo Eddy Lincango¹²,Steele Scott R.¹²,Merchea Amit¹³^ORCID,Shaker Andrew¹³,Gallostra Marc Marti⁴,Kraft Miquel⁴,Kotze Paulo Gustavo¹⁴,Maruyama Beatriz Yuki¹⁴,Wexner Steven D.¹⁵^ORCID,Garoufalia Zoe¹⁵,Chen Zhihui¹⁶,Hahnloser Dieter¹⁷,Rrupa Djana¹⁷,Buskens Christianne¹⁸,Haanappel Anouck¹⁸,Warusavitarne Janindra¹⁹,Williams Katherine J.¹⁹,Christensen Peter¹,Wolthuis Albert⁷,Potolicchio Analia²⁰,Spinelli Antonino⁵⁶

Affiliation:

1. Department of Surgery Aarhus University Hospital Aarhus Denmark

2. General Surgery Department CEMIC Buenos Aires Argentina

3. Department of Advanced Medical and Surgical Sciences Università Degli Studi Della Campania “Luigi Vanvitelli” Naples Italy

4. Colorectal Surgery, Vall d'Hebron University Hospital Universitat Autonoma de Barcelona UAB Barcelona Spain

5. Division of Colon and Rectal Surgery IRCCS – Humanitas Research Hospital Milan Italy

6. Department of Biomedical Sciences Humanitas University Milan Italy

7. Colorectal Surgery Department Leuven University Hospital Leuven Belgium

8. Colorectal Surgery Department Sinai Health Hospital Toronto Ontario Canada

9. Inflammatory Bowel Disease Unit, Gastroenterology Section, Department of Internal Medicine Centro de Educación Médica e Investigaciones Clínicas Buenos Aires Argentina

10. Zane Cohen Centre for Digestive Diseases Lunenfeld‐Tanenbaum Research Institute, Sinai Health System Toronto Ontario Canada

11. Division of Gastroenterology, Mount Sinai Hospital University of Toronto Toronto Ontario Canada

12. Colorectal Surgery Department Cleveland Clinic Cleveland Ohio USA

13. Division of Colon and Rectal Surgery Mayo Clinic Jacksonville Florida USA

14. Colorectal Surgery Unit Pontifícia Universidade Católica Do Paraná (PUCPR) Curitiba Brazil

15. Ellen Leifer Shulman and Steven Shulman Digestive Disease Center Cleveland Clinic Weston Florida USA

16. Gastrointestinal Surgery, First Affiliated Hospital Sun Yat‐Sen University Guangzhou China

17. Colorectal Surgery Department Lausanne University Hospital Lausanne Switzerland

18. Colorectal Surgery Department Amsterdam UMC, Location AMC Amsterdam The Netherlands

19. Colorectal Surgery Department St Marks Hospital Harrow UK

20. Colorectal Surgery Department Bordeaux Cancer Institute Bordeaux France

Abstract

AbstractAimRecent evidence challenges the current standard of offering surgery to patients with ileocaecal Crohn's disease (CD) only when they present complications of the disease. The aim of this study was to compare short‐term results of patients who underwent primary ileocaecal resection for either inflammatory (luminal disease, earlier in the disease course) or complicated phenotypes, hypothesizing that the latter would be associated with worse postoperative outcomes.MethodA retrospective, multicentre comparative analysis was performed including patients operated on for primary ileocaecal CD at 12 referral centres. Patients were divided into two groups according to indication of surgery for inflammatory (ICD) or complicated (CCD) phenotype. Short‐term results were compared.ResultsA total of 2013 patients were included, with 291 (14.5%) in the ICD group. No differences were found between the groups in time from diagnosis to surgery. CCD patients had higher rates of low body mass index, anaemia (40.9% vs. 27%, p < 0.001) and low albumin (11.3% vs. 2.6%, p < 0.001). CCD patients had longer operations, lower rates of laparoscopic approach (84.3% vs. 93.1%, p = 0.001) and higher conversion rates (9.3% vs. 1.9%, p < 0.001). CCD patients had a longer hospital stay and higher postoperative complication rates (26.1% vs. 21.3%, p = 0.083). Anastomotic leakage and reoperations were also more frequent in this group. More patients in the CCD group required an extended bowel resection (14.1% vs. 8.3%, p: 0.017). In multivariate analysis, CCD was associated with prolonged surgery (OR 3.44, p = 0.001) and the requirement for multiple intraoperative procedures (OR 8.39, p = 0.030).ConclusionIndication for surgery in patients who present with an inflammatory phenotype of CD was associated with better outcomes compared with patients operated on for complications of the disease. There was no difference between groups in time from diagnosis to surgery.

Publisher

Wiley

Link

https://onlinelibrary.wiley.com/doi/pdf/10.1111/codi.17056

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