BIOLOGICAL THERAPY AND POST-OPERATIVE OUTCOMES IN CROHN'S DISEASE PATIENTS UNDERGOING REPEAT ILEOCOLIC RESECTION. (22nd January 2022)

• Record Type: Journal Article
• Authors: Horesh, Nir; Freund, Michael; Garoufalia, Zoe; Gefen, Rachel; Zhang, David; Smith, Timothy; Wexner, Steven
• Is Part Of: Inflammatory bowel diseases. Volume 28(2022)Supplement 1
• Page Start: S102
• Page End: S103
• Publication Date: 2022-01-22
• Subjects: Inflammatory bowel diseases -- Periodicals; Colitis, Ulcerative -- Periodicals; Crohn Disease -- Periodicals; Inflammatory Bowel Diseases -- Periodicals; 616.344
• DOI: 10.1093/ibd/izac015.166
• Languages: English
• ISSNs: 1078-0998

Abstract

Abstract: OBJECTIVES: To assess the surgical outcome in Crohn's disease (CD) patients undergoing repeat ileocolic resection treated with biologic therapy prior to the surgical intervention. METHODS: A retrospective analysis of a prospective database including all CD patients who underwent repeat ileocolic resection between 2011 and 2021 was conducted. Patients were divided into two groups: patients treated with biologic therapy prior to surgery and controls. Clinical, peri and post-operative data was extracted from medical records and analyzed. RESULTS: Sixty three patients underwent repeat ileocolic resection for CD. Thirty-two patients (50.8%) were male and the mean age was 52 (range 23-82) years. The most common indication for repeat ileocolic resection was anastomotic stricture in 56 patients (88.9%). The mean time from the index ileocolic resection to the repeat surgery was 14.5 (range 1-53) years. Twenty-seven patients (42.8%) were treated with biologic therapy prior to repeat surgical intervention. No demographic differences were found between the biologic therapy group and the control group including patients' gender (p=0.12), age (p=0.69), median American Society of Anesthesiologists (ASA) score (p=0.56) and body mass index (BMI) (p=0.17). In addition, no differences were found in mean time from the index ileocolic resection (p=0.69), indication for surgery (p=0.22) and pre-operative albumin (p=0.39). Thirty-eight patients (60.3%) underwent repeat ileocolic resection using a laparoscopic approach, with a mean operative time of 225 (range 121-386) minutes. In 19 patients (30.1%) a fistula was identified, while an abscess was seen and drained intra-operatively in 5 patients (7.9%). Overall, the post-operative complication rate was 44.5% (28 patients) and the mean length of stay was 5.7 days. Post-operative complications were found to be more common in the non-biologic therapy group compared to the biologic therapy group (55.6% vs 29.7%, respectively; p=0.04). Conversion rate from a laparoscopic to an open approach was slightly higher in the biologic therapy group compared to the biologic therapy group (40% vs 26.1%, respectively; p=0.36) although it did not amount to a statistical significance. Operative time (226 vs. 225 minutes; p=0.92), mean length of stay (5.1 vs. 6.1 days; p=0.18) and readmission rate (16.6% vs. 11.1%; p=0.72) were similar between the two groups. Multivariate analysis of risk factors for post-operative complications showed that only prior biologic treatment was correlated with a lower risk (HR -0.28, CI 95% -0.5596 to -0.01898; p = 0.03). CONCLUSION: In our series, patients treated with biologic therapy for CD who underwent repeat ileocolic resection had fewer post-operative complications.