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New perspectives on the long-term outcome of segmental colectomy for Crohn’s colitis: an observational study on 200 patients

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background and aims

Surgical management of Crohn’s colitis represents one of the most complex situations in colorectal surgery. Segmental colectomy (SC) and total abdominal colectomy with ileorectal anastomosis (TAC-IRA) are the most common procedures, but there are few available data on their long-term outcome. The aim of the present study was to analyze the long-term outcome of patients who underwent segmental colectomy for Crohn’s colitis, with regard to the risk for total abdominal colectomy.

Methods

In this observational, monocentric, retrospective analysis, we analyzed patients who received a segmental colectomy for Crohn’s colitis at our institution. The database was updated by asking patients to complete a questionnaire by telephone or at the outpatient clinic. Only patients followed up at our Hospital were included. Patients were followed up by a specialized multidisciplinary team (IBD Unit). The primary endpoint was the interval between segmental colectomy and, when performed, total abdominal colectomy.

Results

Between 1973 and 2014, 200 patients underwent segmental colectomy for Crohn’s colitis. The median follow-up was 13.5 years (interquartile range [IQR] 7.8–21.5). Overall, 62 patients (31%) had a surgical recurrence, of these, 42 (21%) received total abdominal colectomy. At multivariate analysis, the presence of ≥ 3 sites (HR = 2.47; 95% CI 1.22–5.00; p = 0.018) and perianal disease (HR = 3.23; 95% CI 1.29–8.07; p = 0.006) proved to be risk factors for total abdominal colectomy.

Conclusions

The risk for surgical recurrence after SC for Crohn’s colitis is acceptable. We recommend a bowel-sparing policy for the treatment of Crohn’s colitis in any case in which the extent of the disease at the moment of surgery makes the conservative approach achievable.

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Acknowledgments

We thank Siro Bagnoli and Francesca Rogai very much for their contribution in obtaining follow-up data, and providing criticism of the manuscript. We also thank Professor Francesco Tonelli for his efforts on behalf of these patients over the years.

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Authors and Affiliations

  1. Digestive Surgery Unit – IBD Unit, Careggi University Hospital, Pad. 16, 1st floor, room 140-141, Largo Brambilla 3, 50134, Florence, Italy

    Stefano Scaringi, Annamaria Di Bella, Luca Boni, Francesco Giudici, Carmela Di Martino, Daniela Zambonin & Ferdinando Ficari

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  1. Stefano Scaringi
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  2. Annamaria Di Bella
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  3. Luca Boni
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  4. Francesco Giudici
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  5. Carmela Di Martino
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  6. Daniela Zambonin
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  7. Ferdinando Ficari
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Contributions

Stefano Scaringi: conception and design, analysis and interpretation of data, critical revision for important intellectual content, and final approval of the version to be published. Annamaria Di Bella: data acquisition, analysis and interpretation, drafting of the article, and final approval of the version to be published. Luca Boni: conception and design, data analysis and interpretation, drafting of the article, and final approval of the version to be published. Francesco Giudici: data acquisition, drafting of the article, and final approval of the version to be published. Ferdinando Ficari: conception and design, critical revision for important intellectual content, and final approval of the version to be published. Carmela Di Martino: data acquisition, drafting of the article, and final approval of the version to be published. Daniela Zambonin: data acquisition, drafting of the article, and final approval of the version to be published.

Part of this paper was presented at the 10th Congress of the European Crohn’s and Colitis Organization as an oral presentation, February 18–21, 2015, Barcelona.

Corresponding author

Correspondence to Stefano Scaringi.

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The authors declare that they have no conflict of interest.

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Scaringi, S., Di Bella, A., Boni, L. et al. New perspectives on the long-term outcome of segmental colectomy for Crohn’s colitis: an observational study on 200 patients. Int J Colorectal Dis 33, 479–485 (2018). https://doi.org/10.1007/s00384-018-2998-6

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  • DOI: https://doi.org/10.1007/s00384-018-2998-6

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