An V, Cohen L, Lawrence M, Thomas M, Andrews J, Moore J. Early surgery in Crohn’s disease a benefit in selected cases. World J Gastrointest Surg 2016; 8(7): 492-500 [PMID: 27462391 DOI: 10.4240/wjgs.v8.i7.492]
Corresponding Author of This Article
Dr. Vinna An, MBBS, FRACS, Department of Colorectal Surgery, Royal Adelaide Hospital, North Terrace Adelaide South Australia 5000, Australia. vinna_an@yahoo.com.au
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Jul 27, 2016; 8(7): 492-500 Published online Jul 27, 2016. doi: 10.4240/wjgs.v8.i7.492
Early surgery in Crohn’s disease a benefit in selected cases
Vinna An, Lauren Cohen, Matthew Lawrence, Michelle Thomas, Jane Andrews, James Moore
Vinna An, Lauren Cohen, Matthew Lawrence, Michelle Thomas, James Moore, Department of Colorectal Surgery, Royal Adelaide Hospital, Adelaide 5000, Australia
Jane Andrews, IBD Service Department of Gastroenterology and School of Medicine, Royal Adelaide Hospital, Adelaide 5000, Australia
Author contributions: An V and Cohen L were involved with the study design, data collection, review of results and preparation of this manuscript; Lawrence M, Thomas M, Andrews J and Moore J were involved with the development of the study concept and design, defining the parameters of the database and review and editing of this manuscript.
Institutional review board statement: This project was reviewed and approved by the Royal Adelaide Hospital Human Research Ethics committee.
Conflict-of-interest statement: For all authors, there are no conflicts of interest to declare.
Data sharing statement: The original de-identified data set can be made available on request to the corresponding author vinna_an@yahoo.com.au.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Vinna An, MBBS, FRACS, Department of Colorectal Surgery, Royal Adelaide Hospital, North Terrace Adelaide South Australia 5000, Australia. vinna_an@yahoo.com.au
Telephone: +61-3-98811800 Fax: +61-3-90127875
Received: January 27, 2016 Peer-review started: January 30, 2016 First decision: March 9, 2016 Revised: March 23, 2016 Accepted: April 7, 2016 Article in press: April 11, 2016 Published online: July 27, 2016
Abstract
AIM: To compare the outcomes of a cohort of Crohn’s disease (CD) patients undergoing early surgery (ES) to those undergoing initial medical therapy (IMT).
METHODS: We performed a review of a prospective database CD patients managed at a single tertiary institution. Inclusion criteria were all patients with ileal or ileocolonic CD between 1995-2014. Patients with incomplete data, isolated colonic or perianal CD were excluded. Primary endpoints included the need for, and time to subsequent surgery. Secondary endpoints included the number and duration of hospital admissions, and medical therapy.
RESULTS: Forty-two patients underwent ES and 115 underwent IMT. The operative intervention rate at 5 years in the ES group was 14.2% vs IMT 31.3% (HR = 0.41, 95%CI: 0.23-0.72, P = 0.041). The ES group had fewer hospital admissions per patient [median 1 vs 3 (P = 0.012)] and fewer patients required anti-TNF therapy than IMT (33.3% vs 57%, P = 0.003). A subgroup analysis of 62 IMT patients who had undergone surgery were compared to ES patients, and showed similar 5 year (from index surgery) re-operation rates 16.1% vs 14.3%. In this subset, a significant difference was still found in median number of hospital admissions favouring ES, 1 vs 2 (P = 0.002).
CONCLUSION: Our data supports other recent studies suggesting that patients with ileocolonic CD may have a more benign disease course if undergoing early surgical intervention, with fewer admissions to hospital and a trend to reduced overall operation rates.
Core tip: This study supports the growing body of evidence that asserts that selected patients with ileocolonic Crohn’s have reduced requirement for medical therapy and a trend to fewer surgical interventions. Expanding on the evidence, this study also demonstrated fewer admissions to hospital for Crohn’s disease related illness.
