Short-term outcomes of surgical treatment for primary ileocaecal Crohn's disease: Results of the Crohn's(urg) study, a multicentre, retrospective, comparative analysis between inflammatory and complicated phenotypes.
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Avellaneda Nicolas, Pellino Gianluca, Maroli Annalisa, Tottrup Anders, Bislenghi Gabriele, Colpaert Jan, D'Hoore Andre, Carvello Michele, Giorgi Lorenzo, Juachon Patrizia, Harsløf Sanne, de Buck Van Overstraeten Anthony, Olivera Pablo A, Gomez Javier, Holubar Stefan D, Naranjo Eddy Lincango, Steele Scott R, Merchea Amit, Shaker Andrew, Gallostra Marc Marti, Kraft Miquel, Kotze Paulo Gustavo, Maruyama Beatriz Yuki, Wexner Steven D, Garoufalia Zoe, Chen Zhihui, Hahnloser Dieter, Rrupa Djana, Buskens Christianne, Haanappel Anouck, Warusavitarne Janindra, Williams Katherine J, Christensen Peter, Wolthuis Albert, Potolicchio Analia, Spinelli Antonino
Аннотация
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.