Copyright
©The Author(s) 2016.
World J Gastrointest Surg. Jul 27, 2016; 8(7): 492-500
Published online Jul 27, 2016. doi: 10.4240/wjgs.v8.i7.492
Published online Jul 27, 2016. doi: 10.4240/wjgs.v8.i7.492
Table 1 Demographic and clinical data n (%)
Initial medical therapy (n = 115) | |||||
Clinical details | Early surgery (n = 42) | IMT (n =115) | P value | DS (n = 62)1 | P value |
Gender M:F | 22:20 | 50:65 | 0.531 | 24:38:00 | 0.227 |
Age at diagnosis (yr), median (IQR) | 34.5 (24-46) | 24 (19-33) | 0.0001 | 23.5 (18.25-31.75) | 0.006 |
Smoking | 15 (35.7) | 43 (37.4) | 0.852 | 25 (40.3) | 0.685 |
Phenotype | |||||
B1 (non-stricturing) | 3 (7.1) | 38 (36.2) | 0.001 | 4 (6.5) | 0.968 |
B2 (stricturing) | 17 (40.5) | 26 (24.8) | 24 (38.7) | ||
B3 (penetrating) | 22 (52.4) | 41 (39.0) | 34 (54.8) | ||
Location | |||||
L1 (ileal) | 28 (66.7) | 25 (24.5) | 0.0001 | 17 (26.3) | 0.0001 |
Perianal disease | 0 | 6 (5.2) | 3 (4.8) | ||
L3 (ileocolonic) | |||||
Perianal disease | 14 (33.3) | 74 (69.4) | 45 (70.2) | ||
5 (11.9) | 40 (34.8) | 16 (25.8) |
Table 2 Indications for early surgery n (%)
Clinical details | Early surgery (n = 42) | Deferred surgery (n = 62) |
Indication for surgery | ||
Acute obstruction – emergency resection | 9 (21.4) | 4 (23.0) |
Subacute obstruction – elective resection | - | 20 (32.3) |
Perforation | 15 (35.7) | 7 (11.3) |
Fistula/phlegmon | 5 (11.9) | 15 (24.2) |
Abdominal pain | 5 (11.9) | 2 (3.2) |
Haemorrhage | 3 (7.1) | - |
Not specified | 5 (11.9) | 14 (23.0) |
Table 3 Comparison of early vs initial medical therapy in Crohn’s disease n (%)
Initial medical therapy (n = 115) | |||||
Clinical details | Early surgery (n = 42) | Initial medical therapy (n = 115) | P value | Deferred surgery (n = 62)1 | P value |
Number requiring surgery | |||||
3 yr | 5 (11.9) | 24 (20.7) | 0.250 | 5 (8.1) | 0.521 |
5 yr | 6 (14.2) | 36 (31.3) | 0.041 | 10 (16.1) | NS |
Completion of study period | 7 (16.7) | 62 (53.9) | < 0.0001 | 20 (32.3) | 0.110 |
Number of admission to hospital per patient, median (IQR) | 1 (1-2) | 3 (1-5) | 0.012 | 2 (1-4.5) | 0.002 |
Days in hospital (d), median (IQR) | 12.5 (9-22.5) | 11 (3-28) | 0.230 | 17 (8-28) | 0.347 |
Medical therapy | |||||
Immune modulator | 32 (76.2) | 101 (87.8) | 0.083 | 54 (87.1) | 0.189 |
Steroids | 12 (28.6) | 34 (29.6) | NS | 23 (37.1) | 0.404 |
Anti-TNF | 14 (33.3) | 69 (60.0) | 0.004 | 42 (67.7) | 0.001 |
No requirement for medical therapy | 10 (23.8) | 5 (4.3) | 0.008 | 0 (0) | < 0.0001 |
Follow-up months (mo), median (IQR) | 67 (31-114) | 97 (58-150) | 64 (19-121) |
Table 4 Comparison of extent of resection performed in early surgery vs deferred surgery cohorts n (%)
Clinical details | Early surgery (n = 42) | Deferred surgery (n = 62) | P value |
Operation | |||
Small bowel resection | 5 (11.9) | 7 (11.3) | NS |
Ileocolic resection | 31 (73.8) | 30 (48.4) | 0.015 |
Small bowel and segmental colonic resection | 3 (7.1) | 9 (14.5) | 0.352 |
Small bowel and total colectomy | 2 (4.8) | 9 (14.5) | 0.193 |
Data unavailable | 1 (2.9) | 7 (11.3) | 0.139 |
Stoma formation | 3 (7.1) | 5 (8.1) | NS |
- Citation: An V, Cohen L, Lawrence M, Thomas M, Andrews J, Moore J. Early surgery in Crohn’s disease a benefit in selected cases. World J Gastrointest Surg 2016; 8(7): 492-500
- URL: https://www.wjgnet.com/1948-9366/full/v8/i7/492.htm
- DOI: https://dx.doi.org/10.4240/wjgs.v8.i7.492