Long-term Oncological Outcome of Segmental Versus Extended Colectomy for Colorectal Cancer in Crohn’s Disease: Results from an International Multicentre Study

Author:

Sensi Bruno1,Khan Jim2ORCID,Warusavitarne Janindra3ORCID,Nardi Alessandra4,Spinelli Antonino5,Zaghiyan Karen6,Panis Yves7,Sampietro Gianluca8,Fichera Alessandro9,Garcia-Granero Eduardo10,Espin-Basany Eloy11,Konishi Tsuyoshi12,Siragusa Leandro1,Stefan Samuel2,Bellato Vittoria3,Carvello Michele5,Adams Evan6,Frontali Alice7,Artigue Michael9,Frasson Matteo10ORCID,Marti-Gallostra Marc11,Pellino Gianluca1213ORCID,Sica Giuseppe S1ORCID

Affiliation:

1. University of Rome Tor Vergata, Department of Surgery, Rome, Italy

2. Portsmouth Hospital, NHS trust, Surgery, Portsmouth, UK

3. Saint Mark’s Hospital, Surgery, London, UK

4. University of Rome Tor Vergata, Department of Mathematics, Rome, Italy

5. Istituto Clinico Humanitas, Colorectal Surgery, Rozzano, Italy

6. Cedars Sinai Hospital, Surgery, Los Angeles, CA, USA

7. Beaujon Hospital, Colorectal Surgery, Paris, France

8. Rho Memorial Hospital, Surgery, Milan, Italy

9. Baylor University Medical Center, Surgery, Dallas, TX, USA

10. Hospital Universitario La Fe, Surgery, Valencia, Spain

11. Hospital Universitario Val d’Hebron, Surgery, Barcelona, Spain

12. MD Anderson Center, Surgery, Houston, TX, USA

13. Università Federico II, Surgery, Napoli, Italy

Abstract

Abstract Background and Aims Crohn’s disease increases colorectal cancer risk, with high prevalence of synchronous and metachronous cancers. Current guidelines for colorectal cancer in Crohn’s disease recommend pan-proctocolectomy. The aim of this study was to evaluate oncological outcomes of a less invasive surgical approach. Methods This was a retrospective database analysis of Crohn’s disease patients with colorectal cancer undergoing surgery at selected European and US tertiary centres. Outcomes of segmental colectomy were compared with those of extended colectomy, total colectomy, and pan-proctocolectomy. Primary outcome was progression-free survival. Secondary outcomes included overall survival, synchronous and metachronous colorectal cancer, and major postoperative complications. Results Ninety-nine patients were included: 66 patients underwent segmental colectomy and 33 extended colectomy. Segmental colectomy patients were older [p = 0.0429], had less extensive colitis [p = 0.0002] and no preoperatively identified synchronous lesions [p = 0.0109]. Median follow-up was 43 [31–62] months. There was no difference in unadjusted progression-free survival [p = 0.2570] or in overall survival [p = 0.4191] between segmental and extended colectomy. Multivariate analysis adjusting for age, sex, ASA score, and AJCC staging, confirmed no difference for progression-free survival (hazard ratio [HR] 1.00, p = 0.9993) or overall survival [HR 0.77, p = 0.6654]. Synchronous and metachronous cancers incidence was 9% and 1.5%, respectively. Perioperative mortality was nil and major complications were comparable [7.58% vs 6.06%, p = 0.9998]. Conclusions Segmental colectomy seems to offer similar long-term outcomes to more extensive surgery. Incidence of synchronous and metachronous cancers appears much lower than previously described. Further prospective studies are warranted to confirm these results.

Publisher

Oxford University Press (OUP)

Subject

Gastroenterology,General Medicine

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3