Retrospective Cohort Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 7, 2021; 27(41): 7159-7172
Published online Nov 7, 2021. doi: 10.3748/wjg.v27.i41.7159
Short-term and long-term outcomes of laparoscopic vs open ileocolic resection in patients with Crohn's disease: Propensity-score matching analysis
Shin Jeong Pak, Young Il Kim, Yong Sik Yoon, Jong Lyul Lee, Jung Bok Lee, Chang Sik Yu
Shin Jeong Pak, Young Il Kim, Yong Sik Yoon, Jong Lyul Lee, Chang Sik Yu, Department of Colon and Rectal Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
Jung Bok Lee, Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
Author contributions: Pak SJ and Kim YI contributed equally to this article; Pak SJ contributed to data acquisition, analysis, and interpretation, and wrote the paper; Yoon YS, Lee JL, Kim YI, and Yu CS generated the data; Lee JB analyzed the data; Yoon YS had the original idea for the paper and provided critical comments, Yoon YS and Kim YI revised the manuscript; and all authors approved the final version of the manuscript.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Asan Medical Center (IRB No. 2019-0972).
Informed consent statement: Informed consent was waived due to the retrospective nature of this study.
Conflict-of-interest statement: This study has no conflict of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yong Sik Yoon, MD, PhD, Associate Professor, Department of Colon and Rectal Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea. yoonys@amc.seoul.kr
Received: March 16, 2021
Peer-review started: March 16, 2021
First decision: May 1, 2021
Revised: May 8, 2021
Accepted: October 18, 2021
Article in press: October 18, 2021
Published online: November 7, 2021
Processing time: 234 Days and 19.8 Hours
Abstract
BACKGROUND

Laparoscopic ileocolic resection (LICR) is the preferred surgical approach for primary ileocolic Crohn’s disease (CD) because it has greater recovery benefits than open ICR (OICR).

AIM

To compare short- and long-term outcomes in patients who underwent LICR and OICR.

METHODS

Patients who underwent ICR for primary CD from 2006 to 2017 at a single tertiary center specializing in CD were included. Patients who underwent LICR and OICR were subjected to propensity-score matching analysis. Patients were propensity-score matched 1:1 by factors potentially associated with 30-d perioperative morbidity. These included demographic characteristics and disease- and treatment-related variables. Factors were compared using univariate and multivariate analyses. Long-term surgical recurrence-free survival (SRFS) in the two groups was determined by the Kaplan-Meier method and compared by the log-rank test.

RESULTS

During the study period, 348 patients underwent ICR, 211 by the open approach and 137 laparoscopically. Propensity-score matching yielded 102 pairs of patients. The rate of postoperative complication was significantly lower (14% versus 32%, P = 0.003), postoperative hospital stay significantly shorter (8 d versus 13 d, P = 0.003), and postoperative pain on day 7 significantly lower (1.4 versus 2.3, P < 0.001) in propensity-score matched patients who underwent LICR than in those who underwent OICR. Multivariate analysis showed that postoperative complications were significantly associated with preoperative treatment with biologics [odds ratio (OR): 3.14, P = 0.01] and an open approach to surgery (OR: 2.86, P = 0.005). The 5- and 10-year SRFS rates in the matched pairs were 92.9% and 83.3%, respectively, with SRFS rates not differing significantly between the OICR and LICR groups. The performance of additional procedures was an independent risk factor for surgical recurrence [hazard ratio (HR): 3.28, P = 0.02].

CONCLUSION

LICR yielded better short-term outcomes and postoperative recovery than OICR, with no differences in long-term outcomes. LICR may provide greater benefits in selected patients with primary CD.

Keywords: Crohn’s disease; Laparoscopic; Surgery; Postoperative complications; Recurrence; Propensity score; Retrospective study

Core Tip: The laparoscopic approach to ileocolic resection can be safely performed in patients with primary Crohn’s disease (CD), resulting in fewer postoperative complications, faster postoperative recovery, and non-inferior surgical recurrence rate when compared with open surgery. Postoperative complications were significantly associated with preoperative use of biologics and open ileocolic resection. Additional procedures were found to be independent risk factors for surgical recurrence in patients with CD.