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P376. Prevalence of surgical treatment of Crohn's disease according to period of diagnosis: preliminary data of a 30-year experience in a single centre

G. Pellino1, M. Patturelli2, A. Cirillo2, L.A. Vastarella2, R. D'Urso2, P. Esposito2, M.I. Russo2, F. Selvaggi1, G. Riegler2, 1Second University of Naples, Unit of General Surgery, Naples, Italy, 2Second University of Naples, Gastroenterology Unit, Department of Clinical and Experimental Medicine, Naples, Italy

Background

The clinical course of inflammatory bowel diseases (IBD) is supposed to be modified by the introduction of new medical therapies and advancements of surgical techniques. Recent data suggest a significant decrease in surgical rates for Crohn's disease (CD). We report on our 30-year experience with need for surgery for CD, according to three different periods of time.

Methods

We retrospectively gathered data of consecutive patients diagnosed with CD in our Centre from before 1991 through 2013 observed in outpatient settings. Patients were subdivided in three subgroups, according to the period of diagnosis (group A, before 1991; group B, 1991–2000; group C, 2001–2013). Data of interest were: age at diagnosis; gender; number and type of interventions; years of follow-up. Duration of follow-up was adjusted according to number of patients and of surgical procedures.

Results

Eighty, 162, and 209 patients were included in groups A, B and C respectively. Two hundred ninety-five procedures (resection; strictureplasty; fistulotomy; fistulectomy; abdominoperineal excision) were performed in 193 patients (42.8%), overall. Table 1 depicts patients' data according to the period of diagnosis.

We observed a trend toward a reduction in need for surgery for each group (72.5%, 50%, and 26%) as well as in ratio of number of procedures per patient (1.65, 1.59, and 1.29 in groups A, B and C respectively). The percentage of patients receiving only one surgery between 1991 and 2013 was as high as 70.3% versus 62% of group A patients. Conversely, when analysing the years of follow-up adjusted on number of surgical procedures performed, we observed a reduction of the disease-free intervals between interventions per patient. This is consistent with an higher density of surgical procedures being performed (12, 7.3 and 4.1 years).

Table 1. Patient characteristics and surgical data according to the period of diagnosis
(A) <1991(B) 1991–2000(C) 2001–2013(B+C) 1991–2013
Surgery/Medical, n (%)58/80 (72.5)81/162 (50)54/209 (25.8)135/371 (36.4)
Gender, M/F29/2944/3730/2474/61
Age, yrs29.932.533.432.7
Surgical procedures, n9612970199
 Procedures/patient1.651.591.291.47
Sum of years of FU, yrs11609372881255
Years of FU/number of patients2011.65.349
Years of FU/surgical procedures127.34.16.3
Only 1 procedure performed, %6265.477.870.3

Conclusion

The density of surgical procedures performed for CD in our Centre seemed to increase along years, although a reduction in number of procedures per patient was observed. This may be the result of a better collaboration between Gastroenterologists and Surgeons dealing with IBD patients, potentially leading to higher success rates of surgery. Our data are preliminary and should be counterbalanced in the light of the different duration of the follow-ups and of the retrospective fashion of our report.