James W T Toh1,2, Nelson Wang2, Christopher J Young2,3, Matthew J F X Rickard2, Anil Keshava2, Peter Stewart2, Viraj Kariyawasam4, Rupert Leong4. 1. Division of Colorectal Surgery, Department of Surgery, Westmead Hospital, The University of Sydney, Westmead Clinical School, Sydney, New South Wales, Australia. 2. Division of Colorectal Surgery, Department of Surgery, Concord Repatriation General Hospital, The University of Sydney, Concord Clinical School, Sydney, New South Wales, Australia. 3. Division of Colorectal Surgery, Department of Surgery, Royal Prince Alfred Hospital, The University of Sydney, Royal Prince Alfred Hospital Clinical School, Sydney, New South Wales, Australia. 4. Department of Gastroenterology, Concord Repatriation General Hospital, The University of Sydney, Concord Clinical School, Sydney, New South Wales, Australia.
Abstract
BACKGROUND: Most patients with Crohn's disease still require surgery despite significant advances in medical therapy, surveillance, and management strategies. OBJECTIVE: The purpose of this study was to assess surgical strategies and outcomes in Crohn's disease, including surgical recurrence and emergency surgery. DESIGN: This was a multicenter, retrospective review of a prospectively collected database. SETTINGS: A specialist-referred cohort of patients with Crohn's disease between 1970 and 2009 was studied. PATIENTS: Included were 972 patients with Crohn's disease who were referred to the Sydney Inflammatory Bowel Disease cohort database. MAIN OUTCOME MEASURES: Main outcomes of interest were the rates of major abdominal and perianal surgery between decades (1970-1979, 1980-1989, 1990-1999, and 2000-2009), indications for surgery, types of procedure performed, rate of elective and emergency surgery, risk of surgical recurrence, and predictive factors for surgery. RESULTS: Between 1970 and 2009, the overall risks of surgery within 5, 10, and 15 years of diagnosis were 31.7%, 43.3%, and 48.4%. The median time to first surgery from time of diagnosis was 2 years (range, 0-31 years). A total of 6.7% of patients required emergency surgery within 5 years of diagnosis. In total, 8.8% of patients required emergency surgery within 15 years. The overall risk of surgical recurrence was 35.9%. The risk of major abdominal surgery significantly decreased between 2000 and 2009 when compared with the 1970 to 1979 period (OR = 0.49 (95% CI, 0.34-0.70). However, the rate of perianal surgery significantly increased (OR = 5.76 (95% CI, 2.54-13.06)). The main indications for surgery were enteric stricture or obstruction, perianal disease, and intra-abdominal fistulas/abscess. Of the 972 patients over 4 decades, only 11 patients (1.1%) were diagnosed with colorectal cancer. LIMITATIONS: This was a specialist-referred cohort, not a population-based study. CONCLUSIONS: The rate of major abdominal surgery has decreased, with surgery reserved for more severe and complicated disease. The natural history of patients with more complicated Crohn's disease and severe phenotypes puts them at higher risk of surgical recurrence and emergency surgery. There has been no reduction in emergency surgery rates and there has been an increase in surgical recurrence despite the reduction in surgical rate morbidity. See Video Abstract at http://links.lww.com/DCR/A483.
BACKGROUND: Most patients with Crohn's disease still require surgery despite significant advances in medical therapy, surveillance, and management strategies. OBJECTIVE: The purpose of this study was to assess surgical strategies and outcomes in Crohn's disease, including surgical recurrence and emergency surgery. DESIGN: This was a multicenter, retrospective review of a prospectively collected database. SETTINGS: A specialist-referred cohort of patients with Crohn's disease between 1970 and 2009 was studied. PATIENTS: Included were 972 patients with Crohn's disease who were referred to the Sydney Inflammatory Bowel Disease cohort database. MAIN OUTCOME MEASURES: Main outcomes of interest were the rates of major abdominal and perianal surgery between decades (1970-1979, 1980-1989, 1990-1999, and 2000-2009), indications for surgery, types of procedure performed, rate of elective and emergency surgery, risk of surgical recurrence, and predictive factors for surgery. RESULTS: Between 1970 and 2009, the overall risks of surgery within 5, 10, and 15 years of diagnosis were 31.7%, 43.3%, and 48.4%. The median time to first surgery from time of diagnosis was 2 years (range, 0-31 years). A total of 6.7% of patients required emergency surgery within 5 years of diagnosis. In total, 8.8% of patients required emergency surgery within 15 years. The overall risk of surgical recurrence was 35.9%. The risk of major abdominal surgery significantly decreased between 2000 and 2009 when compared with the 1970 to 1979 period (OR = 0.49 (95% CI, 0.34-0.70). However, the rate of perianal surgery significantly increased (OR = 5.76 (95% CI, 2.54-13.06)). The main indications for surgery were enteric stricture or obstruction, perianal disease, and intra-abdominal fistulas/abscess. Of the 972 patients over 4 decades, only 11 patients (1.1%) were diagnosed with colorectal cancer. LIMITATIONS: This was a specialist-referred cohort, not a population-based study. CONCLUSIONS: The rate of major abdominal surgery has decreased, with surgery reserved for more severe and complicated disease. The natural history of patients with more complicated Crohn's disease and severe phenotypes puts them at higher risk of surgical recurrence and emergency surgery. There has been no reduction in emergency surgery rates and there has been an increase in surgical recurrence despite the reduction in surgical rate morbidity. See Video Abstract at http://links.lww.com/DCR/A483.
Authors: Christian Galata; Christel Weiss; Julia Hardt; Steffen Seyfried; Stefan Post; Peter Kienle; Karoline Horisberger Journal: Int J Colorectal Dis Date: 2018-05-07 Impact factor: 2.571
Authors: Jurij Hanzel; Ahmed Almradi; Alexandra C Istl; Mei Lucy Yang; Katherine A Fleshner; Claire E Parker; Leonardo Guizzetti; Christopher Ma; Siddharth Singh; Vipul Jairath Journal: Dig Dis Sci Date: 2021-02-26 Impact factor: 3.199
Authors: L W Unger; S Argeny; A Stift; Y Yang; A Karall; T Freilinger; C Müller; M Bergmann; J Stift; S Riss Journal: Colorectal Dis Date: 2019-08-23 Impact factor: 3.788
Authors: Michael Eberhardson; Pär Myrelid; Jonas K Söderling; Anders Ekbom; Åsa H Everhov; Charlotte R H Hedin; Martin Neovius; Jonas F Ludvigsson; Ola Olén Journal: Colorectal Dis Date: 2022-01-22 Impact factor: 3.917
Authors: Susanna Meade; Kamal V Patel; Raphael P Luber; Dearbhaile O'Hanlon; Andra Caracostea; Polychronis Pavlidis; Sailish Honap; Cheran Anandarajah; Nyree Griffin; Sebastian Zeki; Shuvra Ray; Joel Mawdsley; Mark A Samaan; Simon H Anderson; Amir Darakhshan; Katie Adams; Andrew Williams; Jeremy D Sanderson; Miranda Lomer; Peter M Irving Journal: Aliment Pharmacol Ther Date: 2022-06-20 Impact factor: 9.524