Early Ileocecal Resection in Crohn Disease May Reduce Postoperative Complications

Ileocecal resection in the luminal stage of Crohn disease was associated with lower rates of postoperative complications.

Patients who undergo earlier surgical procedures for Crohn disease (CD) have a lower rate of overall postoperative complications compared with patients with CD who have operations for complicated disease, according to a study in Digestive and Liver Disease.

The retrospective SURGICROHN-LATAM study compared patients with CD who had ileocecal resection for luminal disease earlier in the disease course with those who had complicated CD with stenotic or penetrating complications. The study was conducted at 10 academic tertiary centers that specialized in inflammatory bowel disease.

The participants were randomly assigned to 2 groups — early (luminal) operation (early CD [ECD]) and late (complicated) surgery (complicated CD [CCD]). The primary outcome was overall postoperative complication rates between the ECD and CCD groups.

A total of 337 adult patients (median age, 39.78 [range, 18-89] years; women, 53%) with primary ileocecal CD were included — 17.8% in the ECD group and 82.2% in the CCD group.

Our findings suggest that special attention should be given to patients with ileocecal CD who are refractory to medical therapy.

The CCD group had a significantly longer length of surgical procedure (164.25 vs 90.53 minutes, P <.001) and a lower rate of primary anastomosis (90.25% vs 100%, P =.012), compared with the ECD group. The need for an associated procedure also was more common in the CCD group (17.69 vs 6.67%; P =.033; odds ratio [OR], 3.24).

The CCD group had a longer hospitalization length (8.33 vs 6.48 days, P =.208), and greater overall complications (33.21% vs 16.67%; P =.013; OR, 2.49), compared with the ECD group. The major complication rate (Clavien-Dindo classification > IIIa) in the ECD group was 40% vs 51.09% in the CCD group (P =.548). The rate of anastomotic leakage was increased in the CCD group (6.67 vs 1.67%, P =.173).

The CCD group had significantly more reoperations (13.36 vs 3.33%; P =.026; OR, 4.47), although no differences were observed in readmissions or mortality between the 2 groups.

Multivariate analysis showed that smoking (P =.001; 95% CI, 2.59-32.11), operative time (P =.022; 95% CI, 1-1.02), associated procedures (P =.036; 95% CI, 1.09-15.72), and intraoperative complications (P =.021; 95% CI, 1.45-92.31) were independently associated with postoperative complications.

Study limitations include the retrospective design and use of multiple centers. Also, data were analyzed from a convenience sample, with no statistical power calculation. Furthermore, the proposed definition of early resection was not based in time but rather in luminal disease and absence of complications, and some of the variables that were independently related to overall postoperative complications in the multivariable analysis had a large 95% CI range.

“Our findings suggest that special attention should be given to patients with ileocecal CD who are refractory to medical therapy,” the study authors wrote. “Delays in surgical indication may be associated to the development of intrinsic complications of the disease, which are associated to unfavorable postoperative outcomes.”

References:

Avellaneda N, Rodrigues Coy CS, Fillmann HS, et al. Earlier surgery is associated to reduced postoperative morbidity in ileocaecal Crohn’s disease: results from SURGICROHN – LATAM study. Dig Liver Dis. Published online October 27, 2022. doi:10.1016/j.dld.2022.09.011