P321 Postoperative complications after ileo-caecal resection for Crohn's Disease: a prospective multicentre study.
M. Fumery*1, P. Seksik2, M. Chirica3, J.-M. Gornet4, G. Boschetti5, E. Cotte6, A. Buisson7, M. Nachury8, P. Zerbib9, X. Treton10, Y. Panis11, P. Marteau12, K. Pautrat13, C. Sabbagh14, J. filippi15, M. Allez4
1Amiens University Hospital, Hepatogastroenterology, Amiens, France, 2Hopital Saint Antoine , Gastroenterology , Paris, France, 3APHP, Hopital Saint Louis, Digestive surgery, Paris, France, 4APHP, Hopital Saint Louis, Department of Gastroenterology, Paris, France, 5CHU Lyon, Gastroenterology, Lyon, France, 6CHU Lyon, Digestive surgery, Lyon, France, 7CHU de Clermont-Ferrand, Department of Gastroenterology, Clermont-Ferrand, France, 8CHU Lille, Gastroenterology, Lille, France, 9CHU Lille, Digestive surgery, Lille, France, 10Beaujon Hospital, Department of Gastroenterology, Clichy la Garenne, France, 11Beaujon Hospital, Colorectal Surgery, Clichy, France, 12Hopital Lariboisiere, Gastroenterology, Paris, France, 13Hopital Lariboisiere, Digestive surgery, Paris, France, 14Amiens University Hospital, Digestive Surgery, Amiens, France, 15CHU de Nice, Department of Gastroenterology, Nice, France
Most of the data investigating postoperative complications after ileocaecal resection for Crohn's Disease (CD) come from retrospective studies or monocentric cohort. We aimed to determine the frequency and risk factors for early post-operative complication after ileocaecal resection in a well-characterized mutlicentric prospective cohort of CD.
The REMIND group conducted a nationwide study in 9 French academic centres. Patients undergoing ileocaecal resection between 1st September 2010 and 31th September 2014 were included in a prospective cohort. Clinical, biological, surgical data and medical therapies within the 3 months before surgery were prospectively collected. Early postoperative complication was defined by a medical or surgical event within 30 days after surgery. Factors associated with early post-operative complication were searched by univariate and multivariate regression analysis.
211 patients were included. 50% were male with a median age at surgery of 29 years (IQR 25-39). Indications for ileocecal resection were stricturing disease (n=110, 52%), penetrating disease (n=66, 31%), both stricturing and penetrating disease (n=21,10%), and inflammatory disease with failure of medical therapy (n=14, 7%). Seventy-two (34%) patients were exposed to corticosteroids within 3 months before surgery. Ninety-five (45%) and 41 (19%) patients were treated with anti-TNF within 3 and 1 months before surgery. Median duration between the last anti-TNF administration and surgery was 18 days (14-50). Laparoscopy was performed in 115 (70%) patients; 14 (12%) of them needed conversion to laparotomy. Initial stoma was performed in 32 (15%) patients. There was no postoperative death. Forty-three (21%) patients had a total of 56 early post-operative complications after a median time of 5 days (4-12): wound abscess (n=17), intra-abdominal collection (n=16), anastomotic leakage (n=10), extra-intestinal infections (n=9), and haemorrhage (n=5). Reoperation was necessary in 16 patients and stoma in 7. Median duration of temporary stoma was 3.4 months (3.2-6.3). Multivariate analysis found that corticosteroids therapy within 3 months before surgery was the only factor associated to postoperative complications (p=0.04, HR 2.0, IC95%[1.01-4.0]).
In this large multicentre prospective cohort, early postoperative complications after ileocecal resection were observed in 21% of patients. Corticosteroids therapy was the only factor associated to postoperative complications.