P621 Comparison between total abdominal colectomy and segmental colectomy in Crohn's colitis patients: Recurrence and re-resection rates. A retrospective cohort study
H. Tulchinsky*1, M. Bendersky2, H. Yanai3, J. Klausner2, I. Dotan3
1Tel Aviv Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, Colorectal Unit, Department of Surgery, Tel Aviv, Israel, 2Tel Aviv Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, Department of Surgery, Tel Aviv, Israel, 3Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, IBD Center, Department of Gastroenterology and Liver Diseases, Tel Aviv, Israel
Crohn's disease (CD) may potentially affect any part of the gastrointestinal tract. Crohn's colitis is a subgroup of CD involving the colon and rectum. Although medical management has evolved greatly, patients with CD still require surgery as disease progresses. Recent studies that compared segmental colectomy and total abdominal colectomy presented equivocal data regarding recurrence and re-resection rates. The aim of this study was to compare long-term outcomes in regard to recurrence rates and re-resection rates, of segmental versus total/subtotal colectomy in patients with Crohn's colitis (CC), and to identify risk factors associated with post-operative recurrence.
The medical records of all CC patients who underwent colectomy between 1995 and 2013 and were followed at the Tel Aviv Medical Center were identified. Data on age at diagnosis, gender, smoking, disease location at diagnosis, perianal and rectal disease status, indication for surgery, disease duration before operation, type of operation, primary anastomosis at first operation, length of resected specimen, recurrence of symptoms, medication after surgery, re-operation, and total follow-up time were retrieved.
Thirty-five patients (segmental colectomy-18, total/subtotal colectomy-17, male-17, mean age at operation 36.6) were identified. All parameters were comparable between the groups. Mean disease duration prior to first operation was 122.83 months before segmental colectomy and 131.89 months before total/subtotal colectomy (p=0.456). Resuming of medical treatment following surgery was significantly higher in CC patients undergoing segmental colectomy (n=10, 55.55%) compared to those undergoing total/subtotal colectomy (n=15, 88.23%) (p=0.01). Patients undergoing segmental colectomy had significantly longer re-operation-free survival compared to those undergoing total/subtotal colectomy, (p=0.02). A trend towards longer symptom-free survival after segmental colectomy was observed as well, 59+/-13 and 24+/-8 months, respectively (p=0.105); surprisingly, no correlation between the length of resected bowel and survival outcomes was observed (p=0.997 and p=0.319, respectively).
Disease recurrence rate and re-resection rate are not higher after segmental colectomy and therefore segmental resection can be safely performed in limited Crohn's colitis. Further studies should be conducted to explore these potential culprits.