Surgical treatment of colonic Crohn’s disease: a national snapshot study

Abstract

Aim The different surgical options for patients with colonic Crohn’s disease (CD) include segmental colectomy, subtotal colectomy or proctocolectomy with end ileostomy. We present a national, multicentre study, promoted by the Italian Society of Colorectal Surgery with the aim to collect benchmark data and national variations on multidisciplinary management and postoperative outcomes of patients undergoing surgery for colonic CD. Methods All adult patients having elective surgery for colonic CD from June 2018 to May 2019 were eligible for participation in this retrospective study. The primary outcome measure was postoperative morbidity within 30 days of surgery. Results One hundred twenty-two patients were included: 55 subtotal colectomy, 30 segmental colectomy, 25 proctectomy and 12 proctocolectomy. Eighty-six patients (70.4%) were discussed at the inflammatory bowel disease (IBD) multidisciplinary team meeting (MDT) prior to surgery. This ranged from 76.6% for segmental colectomy to 60% for subtotal colectomy, 66.6% for proctocolectomy and 48% for proctectomy. The proportion of patients counselled by a stoma nurse preoperatively was 50%. Laparoscopy was associated with reduced postoperative morbidity (p = 0.017) and shorter length of hospital stay (p < 0.001), whilst pre-operative anti-TNF was associated with Dindo-Clavien ≥ 3 complications (p = 0.023) and longer in-hospital stay (p = 0.007). The main procedure performed (segmental colectomy, subtotal colectomy, proctocolectomy or proctectomy) was not associated with postoperative morbidity (p = 0.626). Conclusions Surgery for colonic CD has a high rate of postoperative complications. Almost a third of the patients were not preoperatively discussed at the IBD MDT, whilst the use of minimally invasive surgery for surgical treatment of colonic CD ranges from 40 to 66%.

Predicting short-term major postoperative complications in intestinal resection for Crohn’s disease: A machine learning-based study

“…Surgical strategies for CD include IR with primary anastomosis or temporary stoma creation followed by delayed anastomosis. The latter is intended to reduce the occurrence of serious complications such as IASC and anastomotic fistula, especially for penetrating disease[ 45 - 47 ] and colonic CD[ 48 , 49 ]. In the cases included in this study, 59.1% of patients underwent staged surgery, and neither penetrating disease nor colectomy was found to be an independent risk factor for major postoperative complications, which again indicates that reasonable selection of staged surgery can effectively reduce postoperative IASC.…”

Surgical Management of Crohn’s Disease: An Overview

“…The reported recurrence rate after this procedure is low, and TPC appears to be the best surgical option to reduce the risk of recurrence [39]. In addition, a recent metaanalysis concluded that segmental colectomy, subtotal colectomy, and proctocolectomy may be equally effective in patients with colonic CD [41].…”

Prehabilitation prior to intestinal resection in Crohn’s disease patients: An opinion review

“…Despite the immediate relief of symptoms and a potential increase of quality of life after CD surgery[ 5 ], important concerns are the risk of potential (severe) complications and recurrence of CD[ 6 ]. Reports on the frequency of postoperative complications, following intestinal resection in CD patients, range from 20%-47%[ 7 - 12 ]. Several general and CD-specific risk factors for postoperative complications have been identified.…”