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Comparative Study
. 2024 Jul;26(7):1415-1427.
doi: 10.1111/codi.17056. Epub 2024 Jun 10.

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

Nicolas Avellaneda  1   2 , Gianluca Pellino  3   4 , Annalisa Maroli  5   6 , Anders Tottrup  1 , Gabriele Bislenghi  7 , Jan Colpaert  7 , Andre D'Hoore  7 , Michele Carvello  5   6 , Lorenzo Giorgi  5 , Patrizia Juachon  5 , Sanne Harsløf  1 , Anthony de Buck Van Overstraeten  8 , Pablo A Olivera  9   10   11 , Javier Gomez  8 , Stefan D Holubar  12 , Eddy Lincango Naranjo  12 , Scott R Steele  12 , Amit Merchea  13 , Andrew Shaker  13 , Marc Marti Gallostra  4 , Miquel Kraft  4 , Paulo Gustavo Kotze  14 , Beatriz Yuki Maruyama  14 , Steven D Wexner  15 , Zoe Garoufalia  15 , Zhihui Chen  16 , Dieter Hahnloser  17 , Djana Rrupa  17 , Christianne Buskens  18 , Anouck Haanappel  18 , Janindra Warusavitarne  19 , Katherine J Williams  19 , Peter Christensen  1 , Albert Wolthuis  7 , Analia Potolicchio  20 , Antonino Spinelli  5   6
Affiliations
Comparative Study

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

Nicolas Avellaneda et al. Colorectal Dis. 2024 Jul.

Abstract

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.

Keywords: Crohn; early; inflammatory; surgery; uncomplicated.

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References

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