Retrospective Study of Surgical Outcomes in 60 Patients with Crohn Disease from a Single Center in Poland

Abstract

Background In Crohn disease (CD), pharmacotherapy with nutritional support is the treatment of choice. However, complications and a lack of response to drugs are indications for surgery. The aim of this study was to present indications for surgery and methods of surgical treatment of CD and to analyze the postoperative morbidity and mortality risk factors. Material/Methods This was a retrospective analysis of adult patients who underwent surgery for CD between January 2015 and January 2019. Sixty of 457 patients (13%) hospitalized for CD required surgical treatment. The parameters age, sex, body mass index, duration, behavior and location of the disease, pharmacotherapy, indications for surgery, type and duration of surgery, perioperative complications, and laboratory tests results were analyzed. Results Most procedures (90%) were elective. The most common indications for surgery were fistulae and strictures. The most frequently performed procedure was right hemicolectomy (60%). Thirty-two percent of patients had postoperative complications. Perianal disease ( P =0.002) and penetrating behavior ( P =0.01) were associated with more surgeries. Stricturing and penetrating behavior was more frequent in patients with ileal/ileocecal involvement than in those with CD affecting the colon ( P =0.039). Patients with smoking history had a significantly lower age at first surgery ( P =0.02). The use of anti-TNF medications appeared to extend time between diagnosis and first surgery ( P =0.014). Conclusions Although the analysis did not reveal any risk factors for perioperative complications, perianal manifestations, penetrating disease type, ileal/ileocecal involvement, and smoking may be associated with risk of earlier surgery or multiple surgeries.

Surgical Outcomes in 62 Patients with Ulcerative Colitis: A Retrospective, Single-Center Study from Poland

“…There are also discussions about the preoperative use of biological treatment and the risk of postoperative complications. Some researchers described the lack of a relationship between increased serum anti-TNF alpha levels and adverse effects after surgery or rehospitalization [27,42,46], which correspond with the results obtained during our analysis and with the observations from a similar study in our clinic [15]. Kunitake et al and Bregnbak et al observed only longer hospitalization time in patients treated with infliximab [46,47], while Schluender et al described significantly more frequent occurrence of postoperative complications during the concomitant use of infliximab and cyclosporin A, with no such effect during treatment only with a biological drug [48].…”

“…A similar study that assessed the most common indications for surgery (ie, fistulae and strictures) and the methods (ie, right hemicolectomy) and results of surgical treatment of another principal type of inflammatory bowel disease, Crohn’s disease, in the same department as our referral Department of Digestive Tract Surgery, University Clinical Center, Medical University of Silesia in Katowice, was performed and the results can be compared with those of the present study [ 5 ]. The aim of our research was to determine the most common indications for surgical treatment of ulcerative colitis, along with methods and results of this procedure.…”

Smoking Is Not an Independent Risk Factor for Surgery in Patients with Crohn’s Disease on Biologic Therapy

“…Smoking is a known risk factor for the development of CD and for worse clinical outcomes among patients who have the disease. Smoking has been associated with increased frequency of disease flares [1][2][3][4], increased need for a firstor second-time surgery [1], and earlier age at which the first surgery was required [5]. Further, several studies have shown that smoking is a risk factor for recurrence of the disease after surgery and for recurrence of fistula [6].…”

“…Although all these different factors have similar patterns of association with both CD and UC, smoking has a distinct interaction with these two diseases. In specific, it has been associated with a detrimental effect on the development and course of CD [4, 5] compared to a possible beneficial effect on the progression of UC [4]. In fact, many studies have confirmed these associations.…”

“…Further, smoking was shown to complicate the course of disease in CD patients with more frequent disease flare-up, higher rates of recurrence after surgery, and an increased chance of requiring a second surgery [5]. Interestingly, smoking cessation was shown to be beneficial in CD patients that also smoke [5]. In addition, it has been suggested that smokers have reduced response to anti-tumor necrosis factor (TNF) therapy and may have lower concentrations of the drug in their blood when compared to nonsmokers [7][8][9][10][11][12] and that smokers have higher levels of anti-TNF antibodies than nonsmokers [7].…”