Treffer: 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.
Title:
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.
Authors:
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.; Colorectal Surgery, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, 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; Colorectal Surgery Department, Leuven University Hospital, Leuven, Belgium., Colpaert J; Colorectal Surgery Department, Leuven University Hospital, Leuven, Belgium., D'Hoore A; Colorectal Surgery Department, Leuven University Hospital, Leuven, Belgium., Carvello M; Division of Colon and Rectal Surgery, IRCCS - Humanitas Research Hospital, Milan, Italy.; Department of Biomedical Sciences, Humanitas University, Milan, Italy., Giorgi L; Division of Colon and Rectal Surgery, IRCCS - Humanitas Research Hospital, Milan, Italy., Juachon P; Division of Colon and Rectal Surgery, IRCCS - Humanitas Research Hospital, Milan, Italy., Harsløf S; Department of Surgery, Aarhus University Hospital, Aarhus, Denmark., de Buck Van Overstraeten A; Colorectal Surgery Department, Sinai Health Hospital, Toronto, Ontario, Canada., Olivera PA; Inflammatory Bowel Disease Unit, Gastroenterology Section, Department of Internal Medicine, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires, Argentina.; Zane Cohen Centre for Digestive Diseases, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada.; Division of Gastroenterology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada., Gomez J; Colorectal Surgery Department, Sinai Health Hospital, Toronto, Ontario, Canada., Holubar SD; Colorectal Surgery Department, Cleveland Clinic, Cleveland, Ohio, USA., Naranjo EL; Colorectal Surgery Department, Cleveland Clinic, Cleveland, Ohio, USA., Steele SR; Colorectal Surgery Department, Cleveland Clinic, Cleveland, Ohio, USA., Merchea A; Division of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, Florida, USA., Shaker A; Division of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, Florida, USA., Gallostra MM; Colorectal Surgery, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain., Kraft M; Colorectal Surgery, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain., Kotze PG; Colorectal Surgery Unit, Pontifícia Universidade Católica Do Paraná (PUCPR), Curitiba, Brazil., Maruyama BY; Colorectal Surgery Unit, Pontifícia Universidade Católica Do Paraná (PUCPR), Curitiba, Brazil., Wexner SD; Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic, Weston, Florida, USA., Garoufalia Z; Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic, Weston, Florida, USA., Chen Z; Gastrointestinal Surgery, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China., Hahnloser D; Colorectal Surgery Department, Lausanne University Hospital, Lausanne, Switzerland., Rrupa D; Colorectal Surgery Department, Lausanne University Hospital, Lausanne, Switzerland., Buskens C; Colorectal Surgery Department, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands., Haanappel A; Colorectal Surgery Department, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands., Warusavitarne J; Colorectal Surgery Department, St Marks Hospital, Harrow, UK., Williams KJ; Colorectal Surgery Department, St Marks Hospital, Harrow, UK., Christensen P; Department of Surgery, Aarhus University Hospital, Aarhus, Denmark., Wolthuis A; Colorectal Surgery Department, Leuven University Hospital, Leuven, Belgium., Potolicchio A; Colorectal Surgery Department, Bordeaux Cancer Institute, Bordeaux, France., Spinelli A; Division of Colon and Rectal Surgery, IRCCS - Humanitas Research Hospital, Milan, Italy.; Department of Biomedical Sciences, Humanitas University, Milan, Italy.
Source:
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland [Colorectal Dis] 2024 Jul; Vol. 26 (7), pp. 1415-1427. Date of Electronic Publication: 2024 Jun 10.
Publication Type:
Journal Article; Multicenter Study; Comparative Study
Language:
English
Journal Info:
Publisher: Blackwell Science Ltd Country of Publication: England NLM ID: 100883611 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1463-1318 (Electronic) Linking ISSN: 14628910 NLM ISO Abbreviation: Colorectal Dis Subsets: MEDLINE
Imprint Name(s):
Original Publication: Oxford, UK : Blackwell Science Ltd.,
MeSH Terms:
Crohn Disease*/surgery , Crohn Disease*/complications , Phenotype* , Postoperative Complications*/etiology , Postoperative Complications*/epidemiology , Ileum*/surgery, Humans ; Female ; Retrospective Studies ; Male ; Adult ; Treatment Outcome ; Middle Aged ; Young Adult ; Cecum/surgery ; Laparoscopy/methods ; Laparoscopy/statistics & numerical data ; Laparoscopy/adverse effects ; Operative Time ; Length of Stay/statistics & numerical data ; Time Factors
References:
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Peyrin‐Biroulet L, Fiorino G, Danese S. First‐line therapy in adult Crohn's disease: who should receive anti‐TNF agents? Nat Rev Gastroenterol Hepatol. 2013;10(6):345–351. https://doi.org/10.1038/nrgastro.2013.31.
Iesaelniks I, Kilger A, Glass H, Obermeier F, Agha A, Schlitt HJ. Perforating Crohn's ileitis: delay of surgery is associated with inferior postoperative outcome. Inflamm Bowel Dis. 2010;16(12):2125–2130. https://doi.org/10.1002/ibd.21303.
Lavorini E, Allaix ME, Ammirati CA, Astegiano M, Morino M, Resegotti A. Late is too late? Surgical timing and postoperative complications after primary ileocolic resection for Crohn's disease. Int J Colorectal Dis. 2022;37(4):843–848. https://doi.org/10.1007/s00384‐022‐04125‐7.
Ponsioen CY, de Groof EJ, Eshuis EJ, Gardenbroek TJ, Bossuyt PMM, Hart A, et al. Laparoscopic ileocaecal resection versus infliximab for terminal ileitis in Crohn's disease: a randomized controlled, open‐label, multicentre trial. Lancet. 2017;2(11):785–792. https://doi.org/10.1016/S2468‐1253(17)30248‐0.
de Groof EJ, Stevens TW, Eshuis EJ, Gardenbroek TJ, Bosmans JE, van Dongen J, et al. Cost‐effectiveness of laparoscopic ileocaecal resection versus infliximab treatment of terminal ileitis in Crohn's disease: the LIR!C trial. Gut. 2019;68(10):1774–1780. https://doi.org/10.1136/gutjnl‐2018‐317539.
Stevens TW, Haasnoot SL, D'Haens GR, Buskens CJ, de Groof EJ, Eshuis EJ, et al. Laparoscopic ileocaecal resection versus infliximab for terminal ileitis in Crohn's disease: retrospective long‐term follow‐up of the LIR!C trial. Lancet. Gastroenterol Hepatol. 2020;5(10):900–907. https://doi.org/10.1016/S2468‐1253(20)30117‐5.
Surgical IBD Latam Consortium, Avellaneda N, Rodrigues Coy CS, Fillmann HS, Saad‐Hossne R, Muñoz JP, et al. Earlier surgery is associated to reduced postoperative morbidity in ileocaecal Crohn's disease: results from SURGICROHN – LATAM Study. Dig Liver Dis. 2022;55:589–594. https://doi.org/10.1016/j.dld.2022.09.011.
Avellaneda N, Haug T, Worm Ørntoft MB, Harsløf S, Skovgaard Larsen LP, Tøttrup A. Short‐term results of operative treatment of primary ileocaecal Crohn's disease. A retrospective, comparative analysis between early (luminal) and complicated disease. J Clin Med. 2023;12:2644.
Gomollon F. Surgery in ileocaecal Crohn's disease: one more option, sometimes the best? Lancet Gastroenterol Hepatol. 2017;2(11):768–769. https://doi.org/10.1016/S2468‐1253(17)30294‐7.
Pellino G, Sampietro GM. Defining the role of abdominal surgery and its impact on the disease course in patients with Crohn's disease: unsolved issues and novel insights. Dig Liver Dis. 2023;55(5):587–588. https://doi.org/10.1016/j.dld.2023.01.159.
Kotze PG, Oliveira Magro D, Real Martinez CA, Spinelli A, Yamamoto T, Warusavitarne J, et al. Long time from diagnosis to surgery may increase postoperative complication rates in elective CD intestinal resections: an observational study. Gastroenterol Res Pract. 2018;2018:4703281. https://doi.org/10.1155/2018/4703281.
Agrawal M, Ebert AC, Poulsen G, Ungaro RC, Faye AS, Jess T, et al. Early ileocecal resection for Crohn's disease is associated with improved long‐term outcomes compared to anti‐tumor necrosis factor therapy: a population‐based cohort study. Gastroenterology. 2023;165(4):976–985.e3. https://doi.org/10.1053/j.gastro.2023.05.051.
Maruyama BY, Ma C, Panaccione R, Kotze PG. Early laparoscopic ileal resection for localized ileocaecal Crohn's disease: hard sell or a revolutionary new norm? Inflamm Intest Dis. 2022;7:13–20. https://doi.org/10.1159/000515959.
Silverberg MS, Satsangi J, Ahmad T, Arnott ID, Bernstein CN, Brant SR, et al. Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a working party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol. 2005;19:5–36.
Bemelman WA, Warusavitarne J, Sampietro GM, Serclova Z, Zmora O, Luglio G, et al. ECCO‐ESCP consensus on surgery for Crohn's disease. J Crohns Colitis. 2018;12:1–16. https://doi.org/10.1093/ecco‐jcc/jjx061.
Rosenthal R, Hoffmann H, Clavien PA, Bucher HC, Dell‐Kuster S. Definition and classification of intraoperative complications (CLASSIC): Delphi study and pilot evaluation. World J Surg. 2015;39(7):1663–1671. https://doi.org/10.1007/s00268‐015‐3003‐y.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–213.
Rahbari NN, Weitz J, Hohenberger W, Heald RJ, Moran B, Ulrich A, et al. Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery. 2010;147(3):339–351. https://doi.org/10.1016/j.surg.2009.10.012.
Lichtenstein G, Loftus E, Isaacs K, Regueiro MD, Gerson LB, Sands BE. ACG clinical guideline: management of Crohn's disease in adults. Am J Gastroenterol. 2018;113(4):481–517. https://doi.org/10.1038/ajg.2018.27.
Gionchetti P, Dignass A, Danese S, Magro Dias FJ, Rogler G, Lakatos PL, et al. 3rd European evidence‐based consensus on the diagnosis and management of Crohn's disease 2016: part 2: surgical management and special situations. J Crohns Colitis. 2017;11(2):135–149. https://doi.org/10.1093/ecco‐jcc/jjw169.
Peyrin‐Biroulet L, Fiorino G, Danese S. First‐line therapy in adult Crohn's disease: who should receive anti‐TNF agents? Nat Rev Gastroenterol Hepatol. 2013;10(6):345–351. https://doi.org/10.1038/nrgastro.2013.31.
Iesaelniks I, Kilger A, Glass H, Obermeier F, Agha A, Schlitt HJ. Perforating Crohn's ileitis: delay of surgery is associated with inferior postoperative outcome. Inflamm Bowel Dis. 2010;16(12):2125–2130. https://doi.org/10.1002/ibd.21303.
Lavorini E, Allaix ME, Ammirati CA, Astegiano M, Morino M, Resegotti A. Late is too late? Surgical timing and postoperative complications after primary ileocolic resection for Crohn's disease. Int J Colorectal Dis. 2022;37(4):843–848. https://doi.org/10.1007/s00384‐022‐04125‐7.
Ponsioen CY, de Groof EJ, Eshuis EJ, Gardenbroek TJ, Bossuyt PMM, Hart A, et al. Laparoscopic ileocaecal resection versus infliximab for terminal ileitis in Crohn's disease: a randomized controlled, open‐label, multicentre trial. Lancet. 2017;2(11):785–792. https://doi.org/10.1016/S2468‐1253(17)30248‐0.
de Groof EJ, Stevens TW, Eshuis EJ, Gardenbroek TJ, Bosmans JE, van Dongen J, et al. Cost‐effectiveness of laparoscopic ileocaecal resection versus infliximab treatment of terminal ileitis in Crohn's disease: the LIR!C trial. Gut. 2019;68(10):1774–1780. https://doi.org/10.1136/gutjnl‐2018‐317539.
Stevens TW, Haasnoot SL, D'Haens GR, Buskens CJ, de Groof EJ, Eshuis EJ, et al. Laparoscopic ileocaecal resection versus infliximab for terminal ileitis in Crohn's disease: retrospective long‐term follow‐up of the LIR!C trial. Lancet. Gastroenterol Hepatol. 2020;5(10):900–907. https://doi.org/10.1016/S2468‐1253(20)30117‐5.
Surgical IBD Latam Consortium, Avellaneda N, Rodrigues Coy CS, Fillmann HS, Saad‐Hossne R, Muñoz JP, et al. Earlier surgery is associated to reduced postoperative morbidity in ileocaecal Crohn's disease: results from SURGICROHN – LATAM Study. Dig Liver Dis. 2022;55:589–594. https://doi.org/10.1016/j.dld.2022.09.011.
Avellaneda N, Haug T, Worm Ørntoft MB, Harsløf S, Skovgaard Larsen LP, Tøttrup A. Short‐term results of operative treatment of primary ileocaecal Crohn's disease. A retrospective, comparative analysis between early (luminal) and complicated disease. J Clin Med. 2023;12:2644.
Gomollon F. Surgery in ileocaecal Crohn's disease: one more option, sometimes the best? Lancet Gastroenterol Hepatol. 2017;2(11):768–769. https://doi.org/10.1016/S2468‐1253(17)30294‐7.
Pellino G, Sampietro GM. Defining the role of abdominal surgery and its impact on the disease course in patients with Crohn's disease: unsolved issues and novel insights. Dig Liver Dis. 2023;55(5):587–588. https://doi.org/10.1016/j.dld.2023.01.159.
Kotze PG, Oliveira Magro D, Real Martinez CA, Spinelli A, Yamamoto T, Warusavitarne J, et al. Long time from diagnosis to surgery may increase postoperative complication rates in elective CD intestinal resections: an observational study. Gastroenterol Res Pract. 2018;2018:4703281. https://doi.org/10.1155/2018/4703281.
Agrawal M, Ebert AC, Poulsen G, Ungaro RC, Faye AS, Jess T, et al. Early ileocecal resection for Crohn's disease is associated with improved long‐term outcomes compared to anti‐tumor necrosis factor therapy: a population‐based cohort study. Gastroenterology. 2023;165(4):976–985.e3. https://doi.org/10.1053/j.gastro.2023.05.051.
Maruyama BY, Ma C, Panaccione R, Kotze PG. Early laparoscopic ileal resection for localized ileocaecal Crohn's disease: hard sell or a revolutionary new norm? Inflamm Intest Dis. 2022;7:13–20. https://doi.org/10.1159/000515959.
Silverberg MS, Satsangi J, Ahmad T, Arnott ID, Bernstein CN, Brant SR, et al. Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a working party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol. 2005;19:5–36.
Bemelman WA, Warusavitarne J, Sampietro GM, Serclova Z, Zmora O, Luglio G, et al. ECCO‐ESCP consensus on surgery for Crohn's disease. J Crohns Colitis. 2018;12:1–16. https://doi.org/10.1093/ecco‐jcc/jjx061.
Rosenthal R, Hoffmann H, Clavien PA, Bucher HC, Dell‐Kuster S. Definition and classification of intraoperative complications (CLASSIC): Delphi study and pilot evaluation. World J Surg. 2015;39(7):1663–1671. https://doi.org/10.1007/s00268‐015‐3003‐y.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–213.
Rahbari NN, Weitz J, Hohenberger W, Heald RJ, Moran B, Ulrich A, et al. Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery. 2010;147(3):339–351. https://doi.org/10.1016/j.surg.2009.10.012.
Lichtenstein G, Loftus E, Isaacs K, Regueiro MD, Gerson LB, Sands BE. ACG clinical guideline: management of Crohn's disease in adults. Am J Gastroenterol. 2018;113(4):481–517. https://doi.org/10.1038/ajg.2018.27.
Gionchetti P, Dignass A, Danese S, Magro Dias FJ, Rogler G, Lakatos PL, et al. 3rd European evidence‐based consensus on the diagnosis and management of Crohn's disease 2016: part 2: surgical management and special situations. J Crohns Colitis. 2017;11(2):135–149. https://doi.org/10.1093/ecco‐jcc/jjw169.
Contributed Indexing:
Keywords: Crohn; early; inflammatory; surgery; uncomplicated
Entry Date(s):
Date Created: 20240611 Date Completed: 20240720 Latest Revision: 20241209
Update Code:
20250114
DOI:
10.1111/codi.17056
PMID:
38858815
Database:
MEDLINE
Weitere Informationen
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.
(© 2024 The Author(s). Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.)