Effectiveness of surgical treatment on colonic Crohn’s disease_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YANG Ying ,  MENG Wenjian , WANG Ziqiang

Department of Gastrointestinal Surgery, West China Hospital of Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

MENG Wenjian, Email: mengwenjian@126.com

Keywords：

colonic Crohn’s disease; inflammatory bowel disease; ulcerative colitis; treatment; effectiveness

DOI：

10.7507/1007-9424.201909086

Video：

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Objective To elucidate the characteristics of colonic Crohn’s disease (CD) and evaluate effectiveness of surgical treatment.Method Clinical data of 28 cases with colonic CD who underwent surgery at West China Hospital of Sichuan University between Feb. 2009 and Jan. 2017 were retrospectively analyzed.Results Definite diagnosis of colonic CD was performed in 12 cases preoperatively (42.9%), but 16 cases (57.1%) were misdiagnosed as other disease, ulcerative colitis (5 cases, 17.9%), tumor (4 cases, 14.3%), appendiceal disease (4 cases, 14.3%), and intestinal tuberculosis (3 cases, 10.7%) were the major causes of preoperative misdiagnosed disease. Of the 28 cases, elective surgery was performed in 26 cases and emergency surgery in 2 cases. The major surgical procedures were segmental colectomy(10 cases) and right hemicolectomy (6 cases), as well as ilecolostomy (9 cases), colocolostomy(6 cases), ileostomy(9 cases), colostomy (6 cases), and so on. The length of the first hospital stay of operation related to intestinal lesions in this group was 5–74 d (mean of 25.4 d). Postoperative complications were occurred in 9 cases (32.1%), all these cases didn’t receave medical treatment. Twenty cases were followed up, and the follow-up time was 7–78 months (mean of 33.4 months), 8 cases lost follow-up. The prognosis of the follow-up cases was good.Conclusions Colonic CD has occult clinical manifestation, resulting in misdiagnosis and mistreatment. Segmental resection of the colon is the important treatment for colonic CD. For patients with complications, multidisciplinary diagnosis and treatment is necessary. In addition, systematic medical treatment before surgery helps to reduce the risk of the first surgery associated with intestinal lesions.

Citation： YANG Ying, MENG Wenjian, WANG Ziqiang. Effectiveness of surgical treatment on colonic Crohn’s disease. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(7): 836-840. doi: 10.7507/1007-9424.201909086 Copy

1.	Bernell O, Lapidus A, Hellers G. Risk factors for surgery and postoperative recurrence in Crohn’s disease. Ann Surg, 2000, 231(1): 38-45.
2.	de Groof EJ, Rossen NG, van Rhijn BD, et al. Burden of disease and increasing prevalence of inflammatory bowel disease in a population-based cohort in the Netherlands. Eur J Gastroenterol Hepatol, 2016, 28(9): 1065-1072.
3.	Silverberg MS, Satsangi J, Ahmad T, et al. Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol, 2005, 19(Suppl A): 5A-36A.
4.	Subramanian S, Ekbom A, Rhodes JM. Recent advances in clinical practice: a systematic review of isolated colonic Crohn’s disease: the third IBD? Gut, 2017, 66(2): 362-381.
5.	Gomollón F, Dignass A, Annese V, et al. 3^rd European evidence-based consensus on the diagnosis and management of Crohn’s disease 2016: part 1: diagnosis and medical management. J Crohns Colitis, 2017, 11(1): 3-25.
6.	Zisman TL, Cohen RD. Pharmacoeconomics and quality of life of current and emerging biologic therapies for inflammatory bowel disease. Curr Treat Options Gastroenterol, 2007, 10(3): 185-194.
7.	Crohn BBGL, Oppenheimer GD. Regional ileitis. A pathologic and clinical entity. J Am Med Assoc, 1932, 99: 1323-1329.
8.	Lockhart-mummery HE, Morson BC. Crohn’s disease (regional enteritis) of the large intestine and its distinction from ulcerative colitis. Gut, 1960, 1: 87-105.
9.	Cleynen I, Boucher G, Jostins L, et al. Inherited determinants of Crohn’s disease and ulcerative colitis phenotypes: a genetic association study. Lancet, 2016, 387(10014): 156-167.
10.	中华医学会病理学分会消化病理学组筹备组, 中华医学会消化病学分会炎症性肠病学组. 中国炎症性肠病组织病理诊断共识意见. 中华病理学杂志, 2014, 43(4): 268-274.
11.	Ponsioen CY, de Groof EJ, Eshuis EJ, et al. Laparoscopic ileocaecal resection versus infliximab for terminal ileitis in Crohn’s disease: a randomised controlled, open-label, multicentre trial. Lancet Gastroenterol Hepatol, 2017, 2(11): 785-792.
12.	de Groof EJ, Stevens TW, Eshuis EJ, et al. Cost-effectiveness of laparoscopic ileocaecal resection versus infliximab treatment of terminal ileitis in Crohn’s disease: the LIR!C Trial. Gut, 2019, 68(10): 1774-1780.
13.	Eshuis EJ, Peters CP, van Bodegraven AA, et al. Ten years of infliximab for Crohn’s disease: outcome in 469 patients from2 tertiary referral centers. Inflamm Bowel Dis, 2013, 19(8): 1622-1630.
14.	Gionchetti P, Dignass A, Danese S, et al. 3rd European evidence-based consensus on the diagnosis and management of Crohn’s disease 2016: part 2: surgical management and special situations. J Crohns Colitis, 2017, 11(2): 135-149.
15.	Picco MF, Zubiaurre I, Adluni M, et al. Immunomodulators are associated with a lower risk of first surgery among patients with non-penetrating non-stricturing Crohn’s disease. Am J Gastroenterol, 2009, 104(11): 2754-2759.
16.	Harper PH, Truelove SC, Lee EC, et al. Split ileostomy and ileocolostomy for Crohn’s disease of the colon and ulcerative colitis: a 20 year survey. Gut, 1983, 24(2): 106-113.
17.	Harb WJ. Crohn’s disease of the colon, rectum, and anus. Surg Clin North Am, 2015, 95(6): 1195-1210.
18.	Sandborn WJ, Fazio VW, Feagan BG, et al. AGA technical review on perianal Crohn’s disease. Gastroenterology, 2003, 125(5): 1508-1530.
19.	Beaugerie L, Seksik P, Nion-Larmurier I, et al. Predictors of Crohn’s disease. Gastroenterology, 2006, 130(3): 650-656.
20.	Lapidus A, Bernell O, Hellers G, et al. Clinical course of colorectal Crohn’s disease: a 35-year follow-up study of 507 patients. Gastroenterology, 1998, 114(6): 1151-1160.
21.	Tarrant KM, Barclay ML, Frampton CM, et al. Perianal disease predicts changes in Crohn’s disease phenotype-results of a population-based study of inflammatory bowel disease phenotype. Am J Gastroenterol, 2008, 103(12): 3082-3093.
22.	Ruffolo C, Citton M, Scarpa M, et al. Perianal Crohn’s disease: is there something new? World J Gastroenterol, 2011, 17(15): 1939-1946.
23.	Maser EA, Sachar DB, Kruse D, et al. High rates of metachronous colon cancer or dysplasia after segmental resection or subtotal colectomy in Crohn’s colitis. Inflamm Bowel Dis, 2013, 19(9): 1827-1832.
24.	Dignass A, Van Assche G, Lindsay JO, et al. The second European evidence-based consensus on the diagnosis and management of Crohn’s disease: current management. J Crohns Colitis, 2010, 4(1): 28-62.
25.	Prudhomme M, Dehni N, Dozois RR, et al. Causes and outcomes of pouch excision after restorative proctocolectomy. Br J Surg, 2006, 93(1): 82-86.
26.	Brown CJ, Maclean AR, Cohen Z, et al. Crohn’s disease and indeterminate colitis and the ileal pouch-anal anastomosis: outcomes and patterns of failure. Dis Colon Rectum, 2005, 48(8): 1542-1549.
27.	Marchal L, D’Haens G, Van Assche G, et al. The risk of post-operative complications associated with infliximab therapy for Crohn’s disease: a controlled cohort study. Aliment Pharmacol Ther, 2004, 19(7): 749-754.
28.	Fichera A, Michelassi F. Surgical treatment of Crohn’s disease. J Gastrointest Surg, 2007, 11(6): 791-803.
29.	Regimbeau JM, Panis Y, Pocard M, et al. Long-term results of ileal pouch-anal anastomosis for colorectal Crohn’s disease. Dis Colon Rectum, 2001, 44(6): 769-778.
30.	Reese GE, Lovegrove RE, Tilney HS, et al. The effect of Crohn’s disease on outcomes after restorative proctocolectomy. Dis Colon Rectum, 2007, 50(2): 239-250.

1. Bernell O, Lapidus A, Hellers G. Risk factors for surgery and postoperative recurrence in Crohn’s disease. Ann Surg, 2000, 231(1): 38-45.
2. de Groof EJ, Rossen NG, van Rhijn BD, et al. Burden of disease and increasing prevalence of inflammatory bowel disease in a population-based cohort in the Netherlands. Eur J Gastroenterol Hepatol, 2016, 28(9): 1065-1072.
3. Silverberg MS, Satsangi J, Ahmad T, et al. Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol, 2005, 19(Suppl A): 5A-36A.
4. Subramanian S, Ekbom A, Rhodes JM. Recent advances in clinical practice: a systematic review of isolated colonic Crohn’s disease: the third IBD? Gut, 2017, 66(2): 362-381.
5. Gomollón F, Dignass A, Annese V, et al. 3^rd European evidence-based consensus on the diagnosis and management of Crohn’s disease 2016: part 1: diagnosis and medical management. J Crohns Colitis, 2017, 11(1): 3-25.
6. Zisman TL, Cohen RD. Pharmacoeconomics and quality of life of current and emerging biologic therapies for inflammatory bowel disease. Curr Treat Options Gastroenterol, 2007, 10(3): 185-194.
7. Crohn BBGL, Oppenheimer GD. Regional ileitis. A pathologic and clinical entity. J Am Med Assoc, 1932, 99: 1323-1329.
8. Lockhart-mummery HE, Morson BC. Crohn’s disease (regional enteritis) of the large intestine and its distinction from ulcerative colitis. Gut, 1960, 1: 87-105.
9. Cleynen I, Boucher G, Jostins L, et al. Inherited determinants of Crohn’s disease and ulcerative colitis phenotypes: a genetic association study. Lancet, 2016, 387(10014): 156-167.
10. 中华医学会病理学分会消化病理学组筹备组, 中华医学会消化病学分会炎症性肠病学组. 中国炎症性肠病组织病理诊断共识意见. 中华病理学杂志, 2014, 43(4): 268-274.
11. Ponsioen CY, de Groof EJ, Eshuis EJ, et al. Laparoscopic ileocaecal resection versus infliximab for terminal ileitis in Crohn’s disease: a randomised controlled, open-label, multicentre trial. Lancet Gastroenterol Hepatol, 2017, 2(11): 785-792.
12. de Groof EJ, Stevens TW, Eshuis EJ, et al. Cost-effectiveness of laparoscopic ileocaecal resection versus infliximab treatment of terminal ileitis in Crohn’s disease: the LIR!C Trial. Gut, 2019, 68(10): 1774-1780.
13. Eshuis EJ, Peters CP, van Bodegraven AA, et al. Ten years of infliximab for Crohn’s disease: outcome in 469 patients from2 tertiary referral centers. Inflamm Bowel Dis, 2013, 19(8): 1622-1630.
14. Gionchetti P, Dignass A, Danese S, et al. 3rd European evidence-based consensus on the diagnosis and management of Crohn’s disease 2016: part 2: surgical management and special situations. J Crohns Colitis, 2017, 11(2): 135-149.
15. Picco MF, Zubiaurre I, Adluni M, et al. Immunomodulators are associated with a lower risk of first surgery among patients with non-penetrating non-stricturing Crohn’s disease. Am J Gastroenterol, 2009, 104(11): 2754-2759.
16. Harper PH, Truelove SC, Lee EC, et al. Split ileostomy and ileocolostomy for Crohn’s disease of the colon and ulcerative colitis: a 20 year survey. Gut, 1983, 24(2): 106-113.
17. Harb WJ. Crohn’s disease of the colon, rectum, and anus. Surg Clin North Am, 2015, 95(6): 1195-1210.
18. Sandborn WJ, Fazio VW, Feagan BG, et al. AGA technical review on perianal Crohn’s disease. Gastroenterology, 2003, 125(5): 1508-1530.
19. Beaugerie L, Seksik P, Nion-Larmurier I, et al. Predictors of Crohn’s disease. Gastroenterology, 2006, 130(3): 650-656.
20. Lapidus A, Bernell O, Hellers G, et al. Clinical course of colorectal Crohn’s disease: a 35-year follow-up study of 507 patients. Gastroenterology, 1998, 114(6): 1151-1160.
21. Tarrant KM, Barclay ML, Frampton CM, et al. Perianal disease predicts changes in Crohn’s disease phenotype-results of a population-based study of inflammatory bowel disease phenotype. Am J Gastroenterol, 2008, 103(12): 3082-3093.
22. Ruffolo C, Citton M, Scarpa M, et al. Perianal Crohn’s disease: is there something new? World J Gastroenterol, 2011, 17(15): 1939-1946.
23. Maser EA, Sachar DB, Kruse D, et al. High rates of metachronous colon cancer or dysplasia after segmental resection or subtotal colectomy in Crohn’s colitis. Inflamm Bowel Dis, 2013, 19(9): 1827-1832.
24. Dignass A, Van Assche G, Lindsay JO, et al. The second European evidence-based consensus on the diagnosis and management of Crohn’s disease: current management. J Crohns Colitis, 2010, 4(1): 28-62.
25. Prudhomme M, Dehni N, Dozois RR, et al. Causes and outcomes of pouch excision after restorative proctocolectomy. Br J Surg, 2006, 93(1): 82-86.
26. Brown CJ, Maclean AR, Cohen Z, et al. Crohn’s disease and indeterminate colitis and the ileal pouch-anal anastomosis: outcomes and patterns of failure. Dis Colon Rectum, 2005, 48(8): 1542-1549.
27. Marchal L, D’Haens G, Van Assche G, et al. The risk of post-operative complications associated with infliximab therapy for Crohn’s disease: a controlled cohort study. Aliment Pharmacol Ther, 2004, 19(7): 749-754.
28. Fichera A, Michelassi F. Surgical treatment of Crohn’s disease. J Gastrointest Surg, 2007, 11(6): 791-803.
29. Regimbeau JM, Panis Y, Pocard M, et al. Long-term results of ileal pouch-anal anastomosis for colorectal Crohn’s disease. Dis Colon Rectum, 2001, 44(6): 769-778.
30. Reese GE, Lovegrove RE, Tilney HS, et al. The effect of Crohn’s disease on outcomes after restorative proctocolectomy. Dis Colon Rectum, 2007, 50(2): 239-250.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Effectiveness of surgical treatment on colonic Crohn’s disease

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