Surgical Resection for Crohn’s and Cancer: A Comparison of Disease-Specific Risk Factors and Outcomes

Abstract

<b><i>Background and Objectives:</i></b> The goal of this study was to compare disease-specific risk factors and 30-day outcomes between patients with Crohn’s disease (CD) and colon cancer (CC) undergoing right-sided surgical resection. <b><i>Methods:</i></b> The American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP<sup>®</sup>) was interrogated to extract all patients ≥18 years undergoing elective right-sided resection for CD versus CC. Independent risk factors for surgical complications were identified through multivariable logistic regression for both groups. In a second step, surgical and medical 30-day morbidity was compared after risk adjustment. <b><i>Results:</i></b> The cohort consisted of 17,516 patients, of which 2,899 (16.6%) underwent surgery for CD versus 14,617 (83.4%) for CC. Independent risk factors for surgical complications in patients with CD were male gender, African American race, ASA score (III or IV), active smoking, prolonged surgery, and preoperative anemia. Independent risk factors for surgical complications in the cancer group were age ≥70 years, male gender, ASA score (III or IV), respiratory and cardiovascular comorbidities, and preoperative hypoalbuminemia (<3.5 g/dL). After risk adjustment, surgical complications (OR 1.25, <i>p</i> = 0.002), sepsis (OR 1.64, <i>p</i> = 0.012), and unplanned readmissions (OR 1.39, <i>p</i> = 0.004) were more common in patients with CD. Thirty-day mortality was higher in cancer patients (1.1 vs. 0.1%, <i>p</i> < 0.0001). <b><i>Conclusions:</i></b> Patients with Crohn’s disease were more prone to surgical complications and postoperative sepsis compared to the cancer group undergoing the same procedure. Careful evaluation and correction of disease-specific modifiable risk factors of patients with CD and CC, respectively, are important.

Incisional Hernia rates between Intracorporeal and Extracorporeal Anastomosis in Minimally Invasive Ileocolic Resection for Crohn's disease

“…The rates of Midline vertical IH (7.9%) and Pfannenstiel IH (0%) in patients with Crohn's disease reported in our study are in line with the literature on right colectomy for colon cancer (Midline 2.2%-22.6%, Pfannenstiel 0-3.8%) [25][26][27][28][29][30][31][32][33][34]. Patients with in ammatory bowel disease have a higher incidence of IH and surgical complications than patients with colon cancer because of multiple surgeries, corticosteroids, malnutrition, smoking, and poor general status [9,19]. However, the IH rate in this cohort was lower than a recent study on patients with cancer reported by Widmar et al [34].…”

“…Up to 30% of patients will have a repeat intestinal resection within 10 years [5]. Ileocolic resection is the most common surgical procedure for CD [1][2][3]6], and minimally invasive surgery (MIS) has improved postoperative outcomes in ileocolic resection for CD [7][8][9][10][11][12][13][14][15].…”

Robotic Redo Ileocolonic Resection for Crohn’s Disease: A Preliminary Report From a Tertiary Care Center

“…Minimally invasive surgery (MIS) shares the same benefits as open approaches with enhanced recovery‚ making it the ideal approach for patients with CD. [9][10][11][12] Unfortunately, conversion rates for laparoscopic approaches remain high secondary to unique features of CD including multifocal disease, high rates of previous surgery, distorted anatomy, and the technical challenges associated with inflamed and friable tissues often observed with chronic immunosuppression and penetrating disease. [13][14][15][16][17][18] The advances of the robotic platform may decrease conversions and allow a more aggressive MIS approach to CD by facilitating complex lysis of adhesions and improved management of intraoperative bleeding associated with mesenteric division that often limits laparoscopic approaches.…”

Oral Antibiotics Bowel Preparation Without Mechanical Preparation for Minimally Invasive Colorectal Surgeries: Current Practice and Future Prospects

“…Mixing different baseline diseases might lead to inaccurate conclusions given important differences (immunosuppression, age, comorbidities). 15 Therefore, postoperative complication profiles, in particular, regarding infectious complications, are expected to be different depending on the underlying disease. Mixing open and laparoscopic approaches may also lead to false conclusions if confounders like the length of incision, surgical duration, or postoperative recovery are considered.…”