P388. Recurrence and long term results of laparoscopic versus open ileo-colonic resection in Crohn's disease. A prospective longitudinal study
E. Iaculli1, C. Fiorani2, O. Sara2, L. Biancone3, T. Giorgia2, R. Pezzuto3, R. Scaramuzzo3, A.L. Gaspari2, G. Sica2, 1Guy's and St Thomas' Hospital, Surgery, London, United Kingdom, 2Tor Vergata Roma, Italy, 3Tor Vergata, Italy
Impairment in host immune response has been demonstrated in pathogenesis of Crohn's disease (CD). Likewise laparoscopic resections for cancer have shown different immunitary modifications when compared to open techniques. Relationship between surgical approaches and the rates and severity of CD recurrence after ileo-colonic (IC) resection are unknown. Aim of this study was to assess whether the surgical approach might affect recurrence amongst 2 groups of CD patients undergoing either laparoscopic (LAP) or open ileo-colonic resection.
100 consecutive patients undergoing elective IC resection by either laparoscopic approach (LAP 43%) or conventional open surgery (OPEN 57%) were enrolled in a prospective longitudinal study. Study protocol includes 3-years follow up (FU). Recurrence was investigated by coloscopy and ileoscopy (RC-I) at 12 and 36 months in all patients, CDAI was assessed every 6 months. Patient's satisfaction to different approach was also analysed with a specific Treatment Satisfaction Questionnaire as part of the protocol. U-Mann Whitney and t-test were used to statistically compare data as appropriate.
Endoscopy was performed in 90 patients (90%) at 1 year and 49 patients (86%) at 3 years. Endoscopic recurrence (Rutgeerts' score >2) was seen in 36% LAP vs 46% OPEN patients at 1 year (p 0.09) and in 48% LAP vs 47% OPEN patients at 3 years (p 0.4). Three patients (1 in the LAP group and 2 in the OPEN group) underwent re-resection during the FU period. Clinical recurrence at 36 months was 2 (8.6%) in the LAP group and 3 (5.2%) in the OPEN group. Patients' satisfaction by specific questionnaire was significantly in favour of laparoscopy also in the long-term assessment.
From preliminary data there was a strong difference although not statistical of endoscopic recurrence rate between laparoscopic group and open group at 1 year assessment. This difference was lost at 3 years. Larger series are required to confirm these outcomes and to explore whether this is due to immunologic definite modifications. Long-term outcome for laparoscopy are comparable to standard procedure. Anyway Treatment Satisfaction assessment showed a strongly significant preference of patients for the mini-invasive approach. Laparoscopic IC resection should be offered to CD patients referred for surgery.