Crohn’s versus Cancer: Comparison of Functional and Surgical Outcomes after Right-Sided Resections

Abstract

Background: The objective of this study was to compare functional and surgical outcomes of patients undergoing ileocecal resection for Crohn’s disease (CD) to patients undergoing oncological right colectomy. Methods: Retrospective single-center cohort study including consecutive patients undergoing right colectomy for adenocarcinoma (oncological resection) or CD (mesentery-sparing resection) between July 2011 and November 2017. Outcome measures were pathological details (lymph node yield), postoperative recovery (pain levels, return to flatus and stool, intake of fluids, weight change, and mobilization), and early (30-day) outcomes (surgical/medical complications, hospital stay, readmissions). Results: A total of 195 patients (153 [78%] with cancer and 42 [22%] with CD) were included. Overall compliance with the institutional enhanced recovery protocol was comparable between the 2 groups (compliance ≥70%: 60% in CD patients vs. 62% in cancer, p = 0.458). The adenocarcinoma group had a larger lymph node yield than the CD group (26 ± 13 vs. 2.4 ± 5, respectively, p < 0.001). While the CD group experienced significantly more pain (3.7 ± 1.9/10 vs. 2.8 ± 2.5/10, p = 0.007, patients requiring opioids: 65 vs. 28%, p = 0.001), return of flatus (2.3 ± 1.2 days vs. 2.4 ± 2.8 days, p = 0.642) and stool (4.1 ± 6.0 vs. 3.0 ± 1.8 days, p = 0.292) was no different in both groups. No difference was observed regarding postoperative complications, length of stay, and readmission rate. Conclusion: This study revealed no differences in both functional and surgical outcomes in CD and cancer patients undergoing mesentery-sparing or formal oncological right colectomy, respectively.

Effect of enhanced recovery after surgery on inflammatory bowel disease surgery: A meta-analysis

“…ERAS might be an effective protocol after IBD surgery. The reduction in hospital stay brings cost savings and reduces the lost work time of family members, improves patient comfort and reduces exposure to hospital-acquired infections at the same time[ 17 ]. Moreover, the likelihood anastomotic fistula was significantly reduced in the ERAS group, which confirmed the safety of the ERAS protocol.…”

“…A few studies suggest the feasibility of ERAS for IBD patients[ 16 ]; however, work comparing the efficiency of ERAS in IBD and non-IBD patients is scant[ 17 ]. Therefore, the purpose of this meta-analysis was to evaluate the safety and efficacy of ERAS in IBD surgery.…”

Mesenteric Excision and Exclusion for Ileocolic Crohn’s Disease: Feasibility and Safety of an Innovative, Combined Surgical Approach With Extended Mesenteric Excision and Kono-S Anastomosis

“…There are ongoing randomized trials, but with respect to safety, it has recently been shown that there does not appear to be any significant difference in functional or surgical outcomes after ICR for CD vs colon cancer operations. 12…”

“…There are ongoing randomized trials, but with respect to safety, it has recently been shown that there does not appear to be any significant difference in functional or surgical outcomes after ICR for CD vs colon cancer operations. 12 Critics of the EME approach have properly pointed out that care must be taken to preserve the vascularity, and length, of the proximal small intestine. 9 Experienced surgeons are familiar with handling the severely inflamed, friable, thickened mesenteric often seen in CD.…”

ECCO Topical Review: Roadmap to Optimal Peri-Operative Care in IBD

“…Current evidence suggests that ERP can improve short-term clinical outcomes immediately after abdominal surgery in patients with IBD (231,232,233,234,235,236,237,238,239,240,241,242,243,244,245,246), and only two studies have mentioned multidisciplinary evaluation and planning prior to discharge (237,242).…”