National variations in perioperative assessment and surgical management of Crohn’s disease: a multicentre study

Celentano, Valerio; Pellino, Gianluca; Rottoli, Matteo; Poggioli, Gilberto; Sica, Giuseppe; Giglio, Mariano Cesare; Campanelli, Michela; Coco, Claudio; Rizzo, Gianluca; Sionne, Francesco; Colombo, Francesco; Sampietro, Gianluca; Lamperti, Giulia; Foschi, Diego; Ficari, Ferdinando; Vacca, Ludovica; Cricchio, Marta; Giudici, Francesco; Selvaggi, Lucio; Sciaudone, Guido; Peltrini, Roberto; Manfreda, Andrea; Bucci, Luigi; Galleano, Raffaele; Ghazouani, Omar; Zorcolo, Luigi; Deidda, Simona; Restivo, Angelo; Braini, Andrea; Candido, Francesca Di; Sacchi, Matteo; Carvello, Michele; Martorana, Stefania; Bordignon, Giovanni; Angriman, Imerio; Variola, Angela; Ruscio, Mirko Di; Barugola, Giuliano; Geccherle, Andrea; Tropeano, Francesca Paola; Luglio, Gaetano; Tanzanu, Marta; Sasia, Diego; Migliore, M.; Giuffrida, Maria Carmela; Marrano, Enrico; Moretto, Gianluigi; Impellizzeri, Harmony; Gallo, Gaetano; Vescio, G; Sammarco, Giuseppe; Terrosu, Giovanni; Calini, Giacomo; Bondurri, Andrea; Maffioli, Anna; Zaffaroni, G; Resegotti, Andrea; Mistrangelo, Massimiliano; Allaix, Marco Ettore; Botti, F.; Prati, M.; Boni, Luigi; Perotti, Serena; Mineccia, Michela; Giuliani, Antonio; Romano, Lucia; Graziano, Giorgio Maria Paolo; Pugliese, Luigi; Pietrabissa, Andrea; Delaini, Gian Gaetano; Spinelli, Antonino; Selvaggi, Francesco

doi:10.1111/codi.15334

Cited by 20 publications

(9 citation statements)

References 20 publications

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“…The present STROBE [11] compliant study evaluates the treatment of colonic CD in Italy. Details have been previously reported [12]. Briefly, after developing the study protocol, which was approved by the SICCR research board, the steering committee invited Italian colorectal units to join the initiative via an open call and newsletters.…”

Section: Study Settingsmentioning

confidence: 99%

Surgical treatment of colonic Crohn’s disease: a national snapshot study

Celentano¹,

Pellino²,

Rottoli³

et al. 2020

Langenbecks Arch Surg

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Aim The different surgical options for patients with colonic Crohn’s disease (CD) include segmental colectomy, subtotal colectomy or proctocolectomy with end ileostomy. We present a national, multicentre study, promoted by the Italian Society of Colorectal Surgery with the aim to collect benchmark data and national variations on multidisciplinary management and postoperative outcomes of patients undergoing surgery for colonic CD. Methods All adult patients having elective surgery for colonic CD from June 2018 to May 2019 were eligible for participation in this retrospective study. The primary outcome measure was postoperative morbidity within 30 days of surgery. Results One hundred twenty-two patients were included: 55 subtotal colectomy, 30 segmental colectomy, 25 proctectomy and 12 proctocolectomy. Eighty-six patients (70.4%) were discussed at the inflammatory bowel disease (IBD) multidisciplinary team meeting (MDT) prior to surgery. This ranged from 76.6% for segmental colectomy to 60% for subtotal colectomy, 66.6% for proctocolectomy and 48% for proctectomy. The proportion of patients counselled by a stoma nurse preoperatively was 50%. Laparoscopy was associated with reduced postoperative morbidity (p = 0.017) and shorter length of hospital stay (p < 0.001), whilst pre-operative anti-TNF was associated with Dindo-Clavien ≥ 3 complications (p = 0.023) and longer in-hospital stay (p = 0.007). The main procedure performed (segmental colectomy, subtotal colectomy, proctocolectomy or proctectomy) was not associated with postoperative morbidity (p = 0.626). Conclusions Surgery for colonic CD has a high rate of postoperative complications. Almost a third of the patients were not preoperatively discussed at the IBD MDT, whilst the use of minimally invasive surgery for surgical treatment of colonic CD ranges from 40 to 66%.

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Section: Study Settingsmentioning

confidence: 99%

Surgical treatment of colonic Crohn’s disease: a national snapshot study

Celentano¹,

Pellino²,

Rottoli³

et al. 2020

Langenbecks Arch Surg

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“…The Italian Society of Colorectal Surgery (SICCR) promoted the snapshot study "Current status of Crohn's disease surgery", which is a retrospective, multicentre, observational study [4] developed according to the STROBE checklist [5]. Ethical approval was obtained from the promoting centres and every participating centre had a named Principal Investigator, liaising with the local ethics committee.…”

Section: Study Settingsmentioning

confidence: 99%

Single-incision laparoscopic surgery (SILS) for the treatment of ileocolonic Crohn’s disease: a propensity score–matched analysis

Celentano

Pellino

Rottoli

et al. 2020

Int J Colorectal Dis

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Introduction Single-incision laparoscopic surgery (SILS) aims to minimize the surgical access trauma by reducing the number of abdominal incisions to a single site, potentially offering better cosmetic results and decreased postoperative pain. In this study, we compare the results of SILS ileocolic resection for Crohn’s disease (CD) to conventional laparoscopy and open surgery using a propensity score–matched analysis in a retrospective national multicentre study. Methods All consecutive patients undergoing elective SILS ileocaecal or redo ileocolic resection for primary and recurrent CD from 1 June 2018 to 31 May 2019 were included. Patients were matched 1:1:1 with laparoscopy and open surgery according to perianal disease, recurrent disease, penetrating phenotype of CD, history of previous abdominal surgery, preoperative medical treatment with steroids and anti-TNF. Postoperative morbidity within 30 days of surgery was the primary endpoint. Results Fifty-eight patients were included in each group, for a total of 174 patients. The conversion rate for SILS and laparoscopy was 10.3% and 12%, respectively, with no difference in the incidence of postoperative complications (13.8% and 12%, p = 0.77), whilst open surgery demonstrated a worse morbidity profile, with a complication rate of 25.9% (p < 0.0001). Median length of hospital stay following SILS ileocolic resection was 5 days, significantly shorter compared to 7 days for laparoscopy and 9 for open surgery (p < 0.0001). Conclusions SILS ileocolonic resection for CD demonstrated a comparable morbidity profile compared to laparoscopy in selected patients, with a reduced length of postoperative hospital stay.

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“…Previous studies in CD surgery have demonstrated significant variability across different hospitals in the volume of surgical procedures performed per year, the short-term surgical outcomes, and the adoption of minimally invasive surgery [ 17 ]. It is not surprising to highlight variations in IBD surgical practice, as similarly, the wide range of available treatments for IBD has been shown to result in significant heterogeneity amongst physicians in the use of biologics and combination therapy, confirming the need for standardised pathways for the care of IBD patients [ 18 ], and guidelines of several international societies have been released to optimize CD outcomes [ 19 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

The INTESTINE study: INtended TEmporary STomas In crohN’s diseasE. Protocol for an international multicentre study

et al. 2022

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Surgery for ileocolonic Crohn’s disease can result in temporary or permanent stoma formation which can be associated with morbidity as parastomal and incisional hernias, readmissions due to obstruction or high stoma output, and have a negative impact on quality of life. We propose an international retrospective trainee-led study of the outcomes of temporary stomas in patients with Crohn’s disease. We aim to evaluate both the short-term (6 month) and mid-term (18 month) outcomes of temporary stomas in patients with Crohn’s Disease. Retrospective, multicentre, observational study including all patients who underwent elective or emergency surgery for ileal, colonic and ileocolonic Crohn’s disease during a 4-year study period. Primary outcome is the proportion of patients who still have an ileostomy or colostomy 18 months after the initial surgery. Secondary outcomes: complications related to stoma formation and stoma reversal surgery; time interval between stoma formation and stoma reversal; risk factors for stoma formation and non-reversal of the stoma. We present the study protocol for a trainee-led, multicentre, observational study. Previous research has demonstrated significant heterogeneity surrounding the formation and the timing of reversal surgery in patients having a temporary ileostomy following colorectal cancer surgery, highlighting the need to address these same questions in Crohn’s disease, which is the aim of our research.

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National variations in perioperative assessment and surgical management of Crohn’s disease: a multicentre study

Cited by 20 publications

References 20 publications

Surgical treatment of colonic Crohn’s disease: a national snapshot study

Surgical treatment of colonic Crohn’s disease: a national snapshot study

Single-incision laparoscopic surgery (SILS) for the treatment of ileocolonic Crohn’s disease: a propensity score–matched analysis

The INTESTINE study: INtended TEmporary STomas In crohN’s diseasE. Protocol for an international multicentre study

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