Sistema de Salut de Catalunya
Institut Català de la Salut
[Avellaneda N] Department of Surgery, Aarhus University Hospital, Aarhus, Denmark. General Surgery Department, CEMIC, Buenos Aires, Argentina. [Pellino G] Department of Advanced Medical and Surgical Sciences, Università Degli Studi Della Campania “Luigi Vanvitelli”, Naples, Italy. Unitat de Cirurgia de Còlon i Recte, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra, Spain. [Maroli A] Division of Colon and Rectal Surgery, IRCCS – Humanitas Research Hospital, Milan, Italy. Department of Biomedical Sciences, Humanitas University, Milan, Italy. [Tottrup A] Department of Surgery, Aarhus University Hospital, Aarhus, Denmark. [Bislenghi G, Colpaert J] Colorectal Surgery Department, Leuven University Hospital, Leuven, Belgium
Vall d'Hebron Barcelona Hospital Campus
2024-08-21T08:01:25Z
2024-08-21T08:01:25Z
2024-07
Crohn; Inflammatory; Surgery
Crohn; Inflamatori; Cirurgia
Crohn; Inflamatorio; Cirugía
Aim Recent evidence challenges the current standard of offering surgery to patients with ileocaecal Crohn's disease (CD) only when they present complications of the disease. The aim of this study was to compare short-term results of patients who underwent primary ileocaecal resection for either inflammatory (luminal disease, earlier in the disease course) or complicated phenotypes, hypothesizing that the latter would be associated with worse postoperative outcomes. Method A retrospective, multicentre comparative analysis was performed including patients operated on for primary ileocaecal CD at 12 referral centres. Patients were divided into two groups according to indication of surgery for inflammatory (ICD) or complicated (CCD) phenotype. Short-term results were compared. Results A total of 2013 patients were included, with 291 (14.5%) in the ICD group. No differences were found between the groups in time from diagnosis to surgery. CCD patients had higher rates of low body mass index, anaemia (40.9% vs. 27%, p < 0.001) and low albumin (11.3% vs. 2.6%, p < 0.001). CCD patients had longer operations, lower rates of laparoscopic approach (84.3% vs. 93.1%, p = 0.001) and higher conversion rates (9.3% vs. 1.9%, p < 0.001). CCD patients had a longer hospital stay and higher postoperative complication rates (26.1% vs. 21.3%, p = 0.083). Anastomotic leakage and reoperations were also more frequent in this group. More patients in the CCD group required an extended bowel resection (14.1% vs. 8.3%, p: 0.017). In multivariate analysis, CCD was associated with prolonged surgery (OR 3.44, p = 0.001) and the requirement for multiple intraoperative procedures (OR 8.39, p = 0.030). Conclusion Indication for surgery in patients who present with an inflammatory phenotype of CD was associated with better outcomes compared with patients operated on for complications of the disease. There was no difference between groups in time from diagnosis to surgery.
Article
Published version
English
Crohn, Malaltia de - Cirurgia; Fenotip; Avaluació de resultats (Assistència sanitària); DISEASES::Digestive System Diseases::Gastrointestinal Diseases::Gastroenteritis::Inflammatory Bowel Diseases::Crohn Disease; Other subheadings::Other subheadings::Other subheadings::/surgery; ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Diagnosis::Prognosis::Treatment Outcome; PHENOMENA AND PROCESSES::Genetic Phenomena::Phenotype; ENFERMEDADES::enfermedades del sistema digestivo::enfermedades gastrointestinales::gastroenteritis::enfermedad inflamatoria intestinal::enfermedad de Crohn; Otros calificadores::Otros calificadores::Otros calificadores::/cirugía; TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::diagnóstico::pronóstico::resultado del tratamiento; FENÓMENOS Y PROCESOS::fenómenos genéticos::fenotipo
Wiley
Colorectal Disease;26(7)
https://doi.org/10.1111/codi.17056
Attribution-NonCommercial-NoDerivatives 4.0 International
http://creativecommons.org/licenses/by-nc-nd/4.0/
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