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; Gianluca Pellino; Annalisa Maroli; Anders Tottrup; Gabriele Bislenghi; Jan Colpaert; Andre D'Hoore; Michele Carvello; Lorenzo Giorgi; Patrizia Juachon; Sanne Harsløf; Anthony de Buck Van Overstraeten; Pablo A. Olivera; Javier Gomez; Stefan D. Holubar; Eddy Lincango Naranjo; Scott R. Steele; Amit Merchea; Andrew Shaker; Marc Marti Gallostra; Miquel Kraft; Paulo Gustavo Kotze; Beatriz Yuki Maruyama; Steven D. Wexner; Zoe Garoufalia; Zhihui Chen; Dieter Hahnloser; Djana Rrupa; Christianne Buskens; Anouck Haanappel; Janindra Warusavitarne; Katherine J. Williams; Peter Christensen; Albert Wolthuis; Analia Potolicchio; Antonino Spinelli

doi:10.1111/codi.17056

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^*, Gianluca Pellino, Annalisa Maroli, Anders Tottrup, Gabriele Bislenghi, Jan Colpaert, Andre D'Hoore, Michele Carvello, Lorenzo Giorgi, Patrizia Juachon, Sanne Harsløf, Anthony de Buck Van Overstraeten, Pablo A. Olivera, Javier Gomez, Stefan D. Holubar, Eddy Lincango Naranjo, Scott R. Steele, Amit Merchea, Andrew Shaker, Marc Marti GallostraMiquel Kraft, Paulo Gustavo Kotze, Beatriz Yuki Maruyama, Steven D. Wexner, Zoe Garoufalia, Zhihui Chen, Dieter Hahnloser, Djana Rrupa, Christianne Buskens, Anouck Haanappel, Janindra Warusavitarne, Katherine J. Williams, Peter Christensen, Albert Wolthuis, Analia Potolicchio, Antonino Spinelli

^*Corresponding author for this work

Department of Surgery

Research output: Contribution to journal › Article › Research › peer-review

2 Citations (Scopus)

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.

Original language	English
Pages (from-to)	1415-1427
Number of pages	13
Journal	Colorectal Disease
Volume	26
Issue number	7
DOIs	https://doi.org/10.1111/codi.17056
Publication status	Published - Jul 2024

Keywords

Crohn
Early
Inflammatory
Surgery
Uncomplicated
Humans
Middle Aged
Laparoscopy/methods
Length of Stay/statistics & numerical data
Postoperative Complications/etiology
Male
Treatment Outcome
Operative Time
Young Adult
Phenotype
Time Factors
Cecum/surgery
Crohn Disease/surgery
Adult
Female
Retrospective Studies
Ileum/surgery

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Avellaneda, N., Pellino, G., Maroli, A., Tottrup, A., Bislenghi, G., Colpaert, J., D'Hoore, A., Carvello, M., Giorgi, L., Juachon, P., Harsløf, S., de Buck Van Overstraeten, A., Olivera, P. A., Gomez, J., Holubar, S. D., Naranjo, E. L., Steele, S. R., Merchea, A., Shaker, A., ... Spinelli, A. (2024). 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. Colorectal Disease, 26(7), 1415-1427. https://doi.org/10.1111/codi.17056

@article{2109f1549501444f953db1c8868d7143,

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",

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, Humans, Middle Aged, Laparoscopy/methods, Length of Stay/statistics & numerical data, Postoperative Complications/etiology, Male, Treatment Outcome, Operative Time, Young Adult, Phenotype, Time Factors, Cecum/surgery, Crohn Disease/surgery, Adult, Female, Retrospective Studies, Ileum/surgery, Crohn, Early, Inflammatory, Surgery, Uncomplicated, Crohn, Early, Inflammatory, Surgery, uncomplicated",

author = "Nicolas Avellaneda and Gianluca Pellino and Annalisa Maroli and Anders Tottrup and Gabriele Bislenghi and Jan Colpaert and Andre D'Hoore and Michele Carvello and Lorenzo Giorgi and Patrizia Juachon and Sanne Harsl{\o}f and {de Buck Van Overstraeten}, Anthony and Olivera, {Pablo A.} and Javier Gomez and Holubar, {Stefan D.} and Naranjo, {Eddy Lincango} and Steele, {Scott R.} and Amit Merchea and Andrew Shaker and Gallostra, {Marc Marti} and Miquel Kraft and Kotze, {Paulo Gustavo} and Maruyama, {Beatriz Yuki} and Wexner, {Steven D.} and Zoe Garoufalia and Zhihui Chen and Dieter Hahnloser and Djana Rrupa and Christianne Buskens and Anouck Haanappel and Janindra Warusavitarne and Williams, {Katherine J.} and Peter Christensen and Albert Wolthuis and Analia Potolicchio and Antonino Spinelli",

note = "{\textcopyright} 2024 The Author(s). Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.",

year = "2024",

month = jul,

doi = "10.1111/codi.17056",

language = "English",

volume = "26",

pages = "1415--1427",

journal = "Colorectal Disease",

issn = "1462-8910",

number = "7",

}

Avellaneda, N, Pellino, G, Maroli, A, Tottrup, A, Bislenghi, G, Colpaert, J, D'Hoore, A, Carvello, M, Giorgi, L, Juachon, P, Harsløf, S, de Buck Van Overstraeten, A, Olivera, PA, Gomez, J, Holubar, SD, Naranjo, EL, Steele, SR, Merchea, A, Shaker, A, Gallostra, MM, Kraft, M, Kotze, PG, Maruyama, BY, Wexner, SD, Garoufalia, Z, Chen, Z, Hahnloser, D, Rrupa, D, Buskens, C, Haanappel, A, Warusavitarne, J, Williams, KJ, Christensen, P, Wolthuis, A, Potolicchio, A & Spinelli, A 2024, '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', Colorectal Disease, vol. 26, no. 7, pp. 1415-1427. https://doi.org/10.1111/codi.17056

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. / Avellaneda, Nicolas; Pellino, Gianluca; Maroli, Annalisa et al.
In: Colorectal Disease, Vol. 26, No. 7, 07.2024, p. 1415-1427.

Research output: Contribution to journal › Article › Research › peer-review

TY - JOUR

T1 - Short-term outcomes of surgical treatment for primary ileocaecal Crohn's disease

T2 - Results of the Crohn's(urg) study, a multicentre, retrospective, comparative analysis between inflammatory and complicated phenotypes

AU - Avellaneda, Nicolas

AU - Pellino, Gianluca

AU - Maroli, Annalisa

AU - Tottrup, Anders

AU - Bislenghi, Gabriele

AU - Colpaert, Jan

AU - D'Hoore, Andre

AU - Carvello, Michele

AU - Giorgi, Lorenzo

AU - Juachon, Patrizia

AU - Harsløf, Sanne

AU - de Buck Van Overstraeten, Anthony

AU - Olivera, Pablo A.

AU - Gomez, Javier

AU - Holubar, Stefan D.

AU - Naranjo, Eddy Lincango

AU - Steele, Scott R.

AU - Merchea, Amit

AU - Shaker, Andrew

AU - Gallostra, Marc Marti

AU - Kraft, Miquel

AU - Kotze, Paulo Gustavo

AU - Maruyama, Beatriz Yuki

AU - Wexner, Steven D.

AU - Garoufalia, Zoe

AU - Chen, Zhihui

AU - Hahnloser, Dieter

AU - Rrupa, Djana

AU - Buskens, Christianne

AU - Haanappel, Anouck

AU - Warusavitarne, Janindra

AU - Williams, Katherine J.

AU - Christensen, Peter

AU - Wolthuis, Albert

AU - Potolicchio, Analia

AU - Spinelli, Antonino

PY - 2024/7

Y1 - 2024/7

N2 - 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.

AB - 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.

KW - Crohn

KW - Early

KW - Inflammatory

KW - Surgery

KW - Uncomplicated

KW - Humans

KW - Middle Aged

KW - Laparoscopy/methods

KW - Length of Stay/statistics & numerical data

KW - Postoperative Complications/etiology

KW - Male

KW - Treatment Outcome

KW - Operative Time

KW - Young Adult

KW - Phenotype

KW - Time Factors

KW - Cecum/surgery

KW - Crohn Disease/surgery

KW - Adult

KW - Female

KW - Retrospective Studies

KW - Ileum/surgery

KW - Crohn

KW - Early

KW - Inflammatory

KW - Surgery

KW - Uncomplicated

KW - Crohn

KW - Early

KW - Inflammatory

KW - Surgery

KW - uncomplicated

UR - http://www.scopus.com/inward/record.url?scp=85195543302&partnerID=8YFLogxK

UR - https://www.mendeley.com/catalogue/f8abf59b-8407-3472-b697-2c2536e74144/

U2 - 10.1111/codi.17056

DO - 10.1111/codi.17056

M3 - Article

C2 - 38858815

AN - SCOPUS:85195543302

SN - 1462-8910

VL - 26

SP - 1415

EP - 1427

JO - Colorectal Disease

JF - Colorectal Disease

IS - 7

ER -

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

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