Risk factors for proctectomy in consecutive Crohn’s colitis surgical patients in a reference colorectal centre

Abstract

Purpose Crohn's colitis carries a risk for permanent stoma with extirpation of the rectum. We aimed to estimate the proctectomy rate and identify risk factors for proctectomy in patients with Crohn's colitis. Methods For this study, we retrospectively reviewed data from consecutive patients with Crohn's disease (CD) affecting the colon or anorectal region undergoing bowel resection in a reference colorectal centre between 2006 and 2016. The cumulative risk for proctectomy was calculated using the Kaplan-Meier curve. We used univariate and multivariate logistic regression analyses to determine independent risk factors for proctectomy. Outcomes after proctectomy concerning reoperation frequency and perineal wound healing are also described. Results In total, this study included 125 patients. Proctectomy was performed in 36 patients (28.8%), of whom 14 patients (38.9%) experienced perineal wound healing problems. The rates of proctectomy were 5.6% and 32.0% 10 and 20 years after CD diagnosis, respectively. Female gender (odds ratio (OR) 3.375, 95% confidence interval (CI) 1.304-8.733, P = 0.012), disease duration (OR 1.067, 95% CI 1.011-1.126, P = 0.018) and history of perianal disease (OR 3.160, 95% CI 1.215-8.219, P = 0.018) were independent risk factors for a proctectomy procedure, whereas thiopurine medication (OR 0.170, 95% CI 0.060-0.486, P = 0.001) was an independent protective factor for proctectomy. Conclusions The duration of Crohn's disease, female gender and a history of perianal disease were significant risk factors for a proctectomy procedure. Future research should examine whether immunosuppressive and biological medications reduce the risk for proctectomy.

Postoperative results and complications of fecal diversion for anorectal Crohn’s disease

“…Several reports have described the proctectomy rates after FD [10][11][12][13][14][15][16][17][18][19][20]. Generally, the proctectomy rate with or without previous FD, ranges from 19.2% to 28.8% [20][21][22][23][24]. The proctectomy rate after FD in our study was 41.3%, which was higher in comparison to previous reports (25%) [13].…”

“…Furthermore, regardless of FD, studies have reported that female sex, duration of CD, history of perineal CD, smoking, and the administration of thiopurines are risk factors for proctectomy [22,24]. We believe that these risk factors require further investigation.…”