Short-term and long-term outcomes of laparoscopic vs open ileocolic resection in patients with Crohn's disease: Propensity-score matching analysis

Abstract

BACKGROUND Laparoscopic ileocolic resection (LICR) is the preferred surgical approach for primary ileocolic Crohn’s disease (CD) because it has greater recovery benefits than open ICR (OICR). AIM To compare short- and long-term outcomes in patients who underwent LICR and OICR. METHODS Patients who underwent ICR for primary CD from 2006 to 2017 at a single tertiary center specializing in CD were included. Patients who underwent LICR and OICR were subjected to propensity-score matching analysis. Patients were propensity-score matched 1:1 by factors potentially associated with 30-d perioperative morbidity. These included demographic characteristics and disease- and treatment-related variables. Factors were compared using univariate and multivariate analyses. Long-term surgical recurrence-free survival (SRFS) in the two groups was determined by the Kaplan-Meier method and compared by the log-rank test. RESULTS During the study period, 348 patients underwent ICR, 211 by the open approach and 137 laparoscopically. Propensity-score matching yielded 102 pairs of patients. The rate of postoperative complication was significantly lower (14% versus 32%, P = 0.003), postoperative hospital stay significantly shorter (8 d versus 13 d, P = 0.003), and postoperative pain on day 7 significantly lower (1.4 versus 2.3, P < 0.001) in propensity-score matched patients who underwent LICR than in those who underwent OICR. Multivariate analysis showed that postoperative complications were significantly associated with preoperative treatment with biologics [odds ratio (OR): 3.14, P = 0.01] and an open approach to surgery (OR: 2.86, P = 0.005). The 5- and 10-year SRFS rates in the matched pairs were 92.9% and 83.3%, respectively, with SRFS rates not differing significantly between the OICR and LICR groups. The performance of additional procedures was an independent risk factor for surgical recurrence [hazard ratio (HR): 3.28, P = 0.02]. CONCLUSION LICR yielded better short-term outcomes and postoperative recovery than OICR, with no differences in long-term outcomes. LICR may provide greater benefits in selected patients with primary CD.

Financial toxicity among patients undergoing resectional surgery for inflammatory bowel disease in the United States

“…Our study also observed reduced hospital admission costs when MIS was used. MIS utilization for IBD-related surgery has been associated with reductions in complication rates and length of hospital stay, as well as reduced rates of reoperation or readmission [16][17][18].…”

“…Our study also observed reduced hospital admission costs when MIS was used. MIS utilization for IBD‐related surgery has been associated with reductions in complication rates and length of hospital stay, as well as reduced rates of reoperation or readmission [16–18]. Due to these benefits, reduced access to this surgical approach among uninsured or publicly insured IBD patients may further increase their risk of financial toxicity after IBD‐related surgery.…”

Comparison of laparoscopic and open ileocecal resection for Crohn’s disease in children

“…There is considerable debate in the literature about use of MIS for CD for many different reasons, but as with many other conditions, when laparoscopic techniques have been used in Crohn’s disease surgery in adults and children, they have been shown to result in shorter hospital stays, faster return to a regular diet, less postoperative narcotic use, and better cosmetic results [ 14 , 23 , 32 ]. These results have been confirmed also in our analysis—postoperative oral intake was started significantly earlier in patients in LG than in OG (LG 1 days versus OG 3 days, p < 0.0001) as well as central venous catheter ( p < 0.0001), parenteral nutrition ( p < 0.0001), postoperative urinary cathetrisation ( p < 0.0001) and need of epidural analgesia ( p = 0.009) were shorter in LG, the length of hospitalisation was also significantly shorter in LG ( p = 0.0005).…”

Mechanisms inherent in acute-to-chronic pain after surgery – risk, diagnostic, predictive, and prognostic factors

“…While some surgeries, such as thoracotomy, mastectomy, or amputations, are considered with a higher risk for the development of CPSP compared to other surgical procedures, the data on prevalence are highly variable. The evidence on a protective effect of laparoscopic versus open surgery is not consistent [13,[126][127][128][129]. The influence of intraoperative factors, such as the duration of surgery or the surgical technique, in terms of extent of nerve damage and invasiveness (e.g.…”