Pak SJ, Kim YI, Yoon YS, Lee JL, Lee JB, Yu CS. Short-term and long-term outcomes of laparoscopic vs open ileocolic resection in patients with Crohn's disease: Propensity-score matching analysis. World J Gastroenterol 2021; 27(41): 7159-7172 [PMID: 34887635 DOI: 10.3748/wjg.v27.i41.7159]
Corresponding Author of This Article
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
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
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
ARTICLE HIGHLIGHTS
Research background
Ileocolic resection (ICR) is the most frequently performed operation for patients with abdominal Crohn’s disease (CD) with involvement of the terminal ileum. Laparoscopic ICR (LICR) has become the preferred surgical approach for primary ileocolic CD because it has greater recovery benefits than open ICR (OICR).
Research motivation
The laparoscopic approach is regarded as more technically challenging than open surgery in CD patients with complex features, including huge phlegmons, multiple enteric fistulas, and dense adhesions, as well as those requiring repeated surgery. Utilization of LICR in patients with complex CD remains problematic.
Research objectives
This study aimed to compare the short- and long-term outcomes of LICR and OICR in patients with primary CD.
Research methods
A total of 348 eligible patients who underwent LICR or OICR for primary CD at Asan Medical Center in Seoul, Korea, from January 2006 to December 2017, were retrospectively analyzed. Data on demographic characteristics, preoperative disease characteristics, operative details, perioperative outcomes, and long-term surgical recurrence were collected. Patients were propensity-score matched 1:1 by factors potentially associated with 30 d perioperative morbidity.
Research results
During the study period, 348 patients underwent ICR, 211 by the open approach and 137 by the laparoscopic approach. Propensity-score matching yielded 102 pairs of patients. The rate of postoperative complications was significantly lower, postoperative hospital stay significantly shorter, and postoperative pain on day 7 significantly lower in patients who underwent laparoscopic than OICR. Surgical recurrence free survival (SRFS) rates in the OICR and LICR groups were not significantly different.
Research conclusions
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.
Research perspectives
The laparoscopic approach to ileocolic resection can be safely performed in patients with primary CD, resulting in fewer postoperative complications, faster postoperative recovery, and non-inferior surgical recurrence rate when compared with open surgery.
