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Avellaneda N, Maroli A, Tottrup A, Buskens C, Kotze PG, Pellino G, Dige A, Haase AM, Haanappel A, Giorgi L, Carvello M, Maruyama BY, Christensen P, Spinelli A. Short and long-term outcomes of surgery for inflammatory (uncomplicated) ileocecal Crohn's disease: Multicentric retrospective analysis of 211 patients. Dig Liver Dis 2023:S1590-8658(23)01006-X. [PMID: 38044224 DOI: 10.1016/j.dld.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/11/2023] [Accepted: 10/19/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Surgical management for patients with inflammatory ileocecal Crohn's disease (CD) could be a reasonable alternative to second-line medical treatment. AIM To assess short and long-term outcomes of patients operated on for inflammatory, ileocecal Crohn's disease. METHODS A retrospective analysis of patients intervened at four referral hospitals during 2012-2021 was performed. RESULTS 211 patients were included. 43% of patients underwent surgery more than 5 years after diagnosis, and 49% had been exposed to at least one biologic agent preoperatively. 89% were operated by laparoscopy, with 1.6% conversion rate. The median length of the resected bowel was 25 cm (7-92) and three patients (1.43%) received a stoma. Median follow-up was 36 (17-70) months. The endoscopic recurrence-free survival proportion at 24, 48, 72, 96, and 120 months was 56%, 52%, 45%, 38%, and 33%, respectively. The clinical recurrence-free survival proportion at 24, 48, 72, 96, and 120 months was 83%, 79%, 76%, 74%, and 74%, respectively. In multivariate analysis, previous biological treatment (HR=2.01; p = 0.001) was associated with a higher risk of overall recurrence. CONCLUSION Surgery in patients with primary inflammatory ileocecal CD is associated with good postoperative outcomes, low postoperative morbidity with reasonable recurrence rates.
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Affiliation(s)
- Nicolas Avellaneda
- Department of Surgery, Aarhus University Hospital, Denmark; General Surgery Department, CEMIC, Buenos Aires, Argentina.
| | - Annalisa Maroli
- Division of Colon and Rectal Surgery, IRCCS - Humanitas Research Hospital, Milano, Italy; Department of Biomedical science, Humanitas University, Milan, Italy
| | - Anders Tottrup
- Department of Surgery, Aarhus University Hospital, Denmark
| | - Christianne Buskens
- Colorectal Surgery Department, Amsterdam Medical Hospitals, Amsterdam, the Netherlands
| | - Paulo Gustavo Kotze
- Colorectal Surgery Unit, Pontifícia Universidade Católica do Paraná (PUCPR), Brazil
| | - Gianluca Pellino
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy; Colorectal Surgery, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain
| | - Anders Dige
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Anne-Mette Haase
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Anouck Haanappel
- Colorectal Surgery Department, Amsterdam Medical Hospitals, Amsterdam, the Netherlands
| | - Lorenzo Giorgi
- Division of Colon and Rectal Surgery, IRCCS - Humanitas Research Hospital, Milano, Italy
| | - Michelle Carvello
- Division of Colon and Rectal Surgery, IRCCS - Humanitas Research Hospital, Milano, Italy; Department of Biomedical science, Humanitas University, Milan, Italy
| | | | | | - Antonino Spinelli
- Division of Colon and Rectal Surgery, IRCCS - Humanitas Research Hospital, Milano, Italy; Department of Biomedical science, Humanitas University, Milan, Italy
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Avellaneda N, Rodrigues Coy CS, Sarubbi Fillmann H, Saad-Hossne R, Muñoz JP, García-Duperly R, Bellolio F, Rotholtz N, Rossi G, Marquez V JR, Cillo M, Lacerda-Filho A, Carrie A, Yuki Maruyama B, Sarubbi Fillmann L, Silvino Craveiro MM, Ferro E, Londoño-Schimmer E, Iglesias A, Bras Harriott C, Campana JP, Londoño Estrada D, Balachandran R, Kotze PG. Risk factors for major complications after surgical treatment of primary ileocecal Crohn's disease. A multicentric Latin American experience. Cir Esp 2023; 101:824-832. [PMID: 37244420 DOI: 10.1016/j.cireng.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 05/29/2023]
Abstract
INTRODUCTION Complications after ileocecal resection for Crohn's disease (CD) are frequent. The aim of this study was to analyze risk factors for postoperative complications after these procedures. MATERIALS AND METHODS We conducted a retrospective analysis of patients treated surgically for Crohn's disease limited to the ileocecal region during an 8-year period at 10 medical centers specialized in inflammatory bowel disease (IBD) in Latin America. Patients were allocated into 2 groups: those who presented major postoperative complications (Clavien-Dindo > II), the "postoperative complication" (POC) group; and those who did not, the "no postoperative complication" (NPOC) group. Preoperative characteristics and intraoperative variables were analyzed to identify possible factors for POC. RESULTS In total, 337 patients were included, with 51 (15.13%) in the POC cohort. Smoking was more prevalent among the POC patients (31.37 vs. 17.83; P = .026), who presented more preoperative anemia (33.33 vs. 17.48%; P = .009), required more urgent care (37.25 vs. 22.38; P = .023), and had lower albumin levels. Complicated disease was associated with higher postoperative morbidity. POC patients had a longer operative time (188.77 vs. 143.86 min; P = .005), more intraoperative complications (17.65 vs. 4.55%; P < .001), and lower rates of primary anastomosis. In the multivariate analysis, both smoking and intraoperative complications were independently associated with the occurrence of major postoperative complications. CONCLUSION This study shows that risk factors for complications after primary ileocecal resections for Crohn's disease in Latin America are similar to those reported elsewhere. Future efforts in the region should be aimed at improving these outcomes by controlling some of the identified factors.
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Affiliation(s)
- Nicolás Avellaneda
- General Surgery Department, Hospital Universitario CEMIC, Argentina; Colorectal Surgery Department, Aarhus University Hospital, Denmark.
| | | | | | | | | | | | - Felipe Bellolio
- Coloproctology Unit, Digestive Surgery Department, Pontíficia Universidad Católica de Chile, Chile
| | - Nicolás Rotholtz
- Colorectal Surgery Service, General Surgery Department, Hospital Aleman de Buenos Aires, Argentina
| | - Gustavo Rossi
- Section of Colorectal Surgery, Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Mariano Cillo
- Colorectal Surgery Department, Hospital Británico de Buenos Aires, Argentina
| | | | - Augusto Carrie
- General Surgery Department, Hospital Universitario CEMIC, Argentina
| | - Beatriz Yuki Maruyama
- Colorectal Surgery Unit, Pontificia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
| | | | | | - Ezequiel Ferro
- Colorectal Surgery Department, Nueva Proctología, Argentina
| | | | - Andrés Iglesias
- Coloproctology Unit, Digestive Surgery Department, Pontíficia Universidad Católica de Chile, Chile
| | - Camila Bras Harriott
- Colorectal Surgery Service, General Surgery Department, Hospital Aleman de Buenos Aires, Argentina
| | - Juan Pablo Campana
- Section of Colorectal Surgery, Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Paulo Gustavo Kotze
- Colorectal Surgery Unit, Pontificia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
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Maruyama BY, Ma C, Panaccione R, Kotze PG. Early Laparoscopic Ileal Resection for Localized Ileocecal Crohn's Disease: Hard Sell or a Revolutionary New Norm? Inflamm Intest Dis 2022; 7:13-20. [PMID: 35224013 PMCID: PMC8820134 DOI: 10.1159/000515959] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/17/2021] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Despite reductions in surgical rates that have been observed with earlier use of biological therapy, surgery still constitutes an important tool in the therapeutic armamentarium in Crohn's disease (CD), particularly in patients with stenotic and penetrating phenotypes. In these scenarios, early surgical intervention is recommended, as bowel damage is present and irreversible, leading to lower efficacy with biologics. SUMMARY The concept of early surgery in CD supposes the possible advantages of better surgical outcomes in luminal CD after initial resection. Optimal timing of surgical intervention is associated with better postoperative outcomes, whilst delays can lead to more technically difficult and extensive procedures, which may result in an increase in postoperative complication rates and higher rates of stoma formation. Furthermore, data from the LIR!C trial have demonstrated that early surgery in luminal localized inflammatory ileocecal CD is an adequate alternative to medical therapy, with lower societal costs in the long term. In this review, we discuss the position of early resection in ileocecal CD by critically reviewing available data, describing the ideal patients to be considered for early surgery, and weighing the potential advantages and disadvantages of an early surgery paradigm. KEY MESSAGES While early surgery may not be the right choice for every patient, the ultimate decision regarding whether surgical or medical therapy should come first in the treatment paradigm must be individualized for each patient based on the disease characteristics, phenotype, risk factors, and personal preference. This highlights the importance of the multidisciplinary team, which remains a key pillar in deciding the overall management plan for patients with CD.
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Affiliation(s)
- Beatriz Yuki Maruyama
- Colorectal Surgery Unit, IBD Outpatient Clinics, Pontificia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
| | - Christopher Ma
- IBD Unit, Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Remo Panaccione
- IBD Unit, Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Paulo Gustavo Kotze
- Colorectal Surgery Unit, IBD Outpatient Clinics, Pontificia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
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