Surgical treatment of colonic Crohn’s disease: a national snapshot study

• Published in: Langenbeck's archives of surgery Vol. 406; no. 4; pp. 1165 - 1172
• Main Authors: Celentano, Valerio, Pellino, Gianluca, Rottoli, Matteo, Poggioli, Gilberto, Sica, Giuseppe, Giglio, Mariano Cesare, Campanelli, Michela, Coco, Claudio, Rizzo, Gianluca, Sionne, Francesco, Colombo, Francesco, Sampietro, Gianluca, Lamperti, Giulia, Foschi, Diego, Ficari, Ferdinando, Vacca, Ludovica, Cricchio, Marta, Giudici, Francesco, Selvaggi, Lucio, Sciaudone, Guido, Peltrini, Roberto, Manfreda, Andrea, Bucci, Luigi, Galleano, Raffaele, Ghazouani, Omar, Zorcolo, Luigi, Deidda, Simona, Restivo, Angelo, Braini, Andrea, Di Candido, Francesca, Sacchi, Matteo, Carvello, Michele, Martorana, Stefania, Bordignon, Giovanni, Angriman, Imerio, Variola, Angela, Barugola, Giuliano, Di Ruscio, Mirko, Tanzanu, Marta, Geccherle, Andrea, Tropeano, Francesca Paola, Luglio, Gaetano, Sasia, Diego, Migliore, Marco, Giuffrida, Maria Carmela, Marrano, Enrico, Moretto, Gianluigi, Impellizzeri, Harmony, Gallo, Gaetano, Vescio, Giuseppina, Sammarco, Giuseppe, Terrosu, Giovanni, Calini, Giacomo, Bondurri, Andrea, Maffioli, Anna, Zaffaroni, Gloria, Resegotti, Andrea, Mistrangelo, Massimiliano, Allaix, Marco Ettore, Botti, Fiorenzo, Prati, Matteo, Boni, Luigi, Perotti, Serena, Mineccia, Michela, Giuliani, Antonio, Romano, Lucia, Graziano, Giorgio Maria Paolo, Pugliese, Luigi, Pietrabissa, Andrea, Delaini, Gian Gaetano, Spinelli, Antonino, Selvaggi, Francesco
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.06.2021
• Subjects: Abdominal Surgery; Adult; Cardiac Surgery; Colectomy; Crohn Disease - surgery; General Surgery; Humans; Ileostomy; Medicine; Medicine & Public Health; Original; Original Article; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Proctocolectomy, Restorative; Retrospective Studies; Thoracic Surgery; Traumatic Surgery; Tumor Necrosis Factor Inhibitors; Vascular Surgery; Inflammatory bowel disease; Segmental colectomy; Proctocolectomy; National audit; Crohn’s disease; Crohn’s colitis
• ISSN: 1435-2443; 1435-2451; 1435-2451
• DOI: 10.1007/s00423-020-02038-z

Aim The different surgical options for patients with colonic Crohn’s disease (CD) include segmental colectomy, subtotal colectomy or proctocolectomy with end ileostomy. We present a national, multicentre study, promoted by the Italian Society of Colorectal Surgery with the aim to collect benchmark data and national variations on multidisciplinary management and postoperative outcomes of patients undergoing surgery for colonic CD. Methods All adult patients having elective surgery for colonic CD from June 2018 to May 2019 were eligible for participation in this retrospective study. The primary outcome measure was postoperative morbidity within 30 days of surgery. Results One hundred twenty-two patients were included: 55 subtotal colectomy, 30 segmental colectomy, 25 proctectomy and 12 proctocolectomy. Eighty-six patients (70.4%) were discussed at the inflammatory bowel disease (IBD) multidisciplinary team meeting (MDT) prior to surgery. This ranged from 76.6% for segmental colectomy to 60% for subtotal colectomy, 66.6% for proctocolectomy and 48% for proctectomy. The proportion of patients counselled by a stoma nurse preoperatively was 50%. Laparoscopy was associated with reduced postoperative morbidity ( p  = 0.017) and shorter length of hospital stay ( p  < 0.001), whilst pre-operative anti-TNF was associated with Dindo-Clavien ≥ 3 complications ( p  = 0.023) and longer in-hospital stay ( p  = 0.007). The main procedure performed (segmental colectomy, subtotal colectomy, proctocolectomy or proctectomy) was not associated with postoperative morbidity ( p  = 0.626). Conclusions Surgery for colonic CD has a high rate of postoperative complications. Almost a third of the patients were not preoperatively discussed at the IBD MDT, whilst the use of minimally invasive surgery for surgical treatment of colonic CD ranges from 40 to 66%.