Surgical treatment and prognosis of incidental Crohn′s disease during operation

Objective To explore the surgical treatment and prognosis of incidental Crohn′s disease (CD) during operation. Methods The retrospective cohort study was conducted. The clinical data of 81 patients who were originally diagnosed with incidental CD during operation and admitted to the Sir Run Run Shaw Hospital of Zhejiang University School of Medicine between January 2012 to June 2016 were collected. Thirty-one patients underwent surgical treatment after relative examinations according to the clinical manifestation and 50 referrals after the operation underwent relative treatment. Observation indicators included (1) overall surgical situations: surgical indications, surgical procedures and postoperative complications. (2) Subsequent treatment: postoperative medication. (3) Follow-up: CD-related reoperation (excluding reoperation due to initial surgery-related complication, ostomy reversal and anal fistula operation). Follow-up using outpatient examination and telephone interview was performed to detect the CD-related reoperation up to August 2016. SPSS software was used for all statistical analyses. Measurement data with normal distribution were represented as ±s, and measurement data with skewed distribution were described as M (range). Count data were analyzed using the Fisher exact probability. The reoperation curve was drawn by the Kaplan-Meier method. Results (1) Overall surgical situations: ① surgical indications: of 81 patients, 23, 22, 17, 7, 5, 4, 1, 1, and 1 patients had respectively acute appendicitis, gastrointestinal tract obstruction, gastrointestinal perforation, intra-abdominal abscess or gastrointestinal hemorrhage, suspected intestinal tumor, intestinal fistula, foreign bodies in intestinal tract and enterovesical fistula. Sixty-three patients underwent emergency operations and 18 underwent selective operations. ② Surgical procedures: single appendectomy, ileocecal resection, segmental resection of colon, segmental resection of small intestine, simple repair of perforation, distal subtotal gastrectomy and foreign bodies removal in intestine tract+ repair were performed in 17, 14, 9, 36, 3, 1 and 1 patients, respectively. ③ Postoperative complications: of 81 patients, 15 had postoperative complications in Clavien-Dindo Grade Ⅱand above, including 12 with intestinal fistula or abdominal abscess and 3 with intestinal obstruction. (2) Subsequent treatment: 66 of 81 patients received postoperative medication for CD (some patients received multiple treatments), including 40 using immuno-suppressive agents, 34 using mesalamine, 22 using biologics and 18 using steroids therapy. (3) Follow-up: all the 81 patients were followed up for 6 months to 23 years, with a median time of 3 years. Twenty-four patients underwent reoperations due to the surgical recurrence during the follow-up. The 3-, 5-, 10-year reoperation rates were 12.3%, 17.3% and 24.7%, respectively. Conclusion Surgeons should enhance the recognition to select the proper surgical treatment for incidental CD during operation and improve the prognosis of patients. Key words: Crohn′s disease; Surgical procedures, operative; Complications; Recurrence