Details

Autor(en) / Beteiligte

• Fumery, Mathurin
• Seksik, Philippe
• Auzolle, Claire
• Munoz-Bongrand, Nicolas
• Gornet, Jean-Marc
• Boschetti, Gilles
• Cotte, Eddy
• Buisson, Anthony
• Dubois, Anne
• Pariente, Benjamin
• Zerbib, Philippe
• Chafai, Najim
• Stefanescu, Carmen
• Panis, Yves
• Marteau, Philippe
• Pautrat, Karine
• Sabbagh, Charles
• Filippi, Jerome
• Chevrier, Marc
• Houze, Pascal
• Jouven, Xavier
• Treton, Xavier
• Allez, Matthieu

Titel

Postoperative Complications after Ileocecal Resection in Crohn's Disease: A Prospective Study From the REMIND Group

Ist Teil von

• The American journal of gastroenterology, 2017-02, Vol.112 (2), p.337-345

Ort / Verlag

United States: Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins

Erscheinungsjahr

2017

Link zum Volltext

Quelle

MEDLINE

Beschreibungen/Notizen

• We sought to determine the frequency of and risk factors for early (30-day) postoperative complications after ileocecal resection in a well-characterized, prospective cohort of Crohn's disease patients. The REMIND group performed a nationwide study in 9 French university medical centers. Clinical-, biological-, surgical-, and treatment-related data on the 3 months before surgery were collected prospectively. Patients operated on between 1 September 2010 and 30 August 2014 were included. A total of 209 patients were included. The indication for ileocecal resection was stricturing disease in 109 (52%) cases, penetrating complications in 88 (42%), and medication-refractory inflammatory disease in 12 (6%). A two-stage procedure was performed in 33 (16%) patients. There were no postoperative deaths. Forty-three (21%) patients (23% of the patients with a one-stage procedure vs. 9% of those with a two-stage procedure, P=0.28) experienced a total of 54 early postoperative complications after a median time interval of 5 days (interquartile range, 4-12): intra-abdominal septic complications (n=38), extra-intestinal infections (n=10), and hemorrhage (n=6). Eighteen complications (33%) were severe (Dindo-Clavien III-IV). Reoperation was necessary in 14 (7%) patients, and secondary stomy was performed in 8 (4.5%). In a multivariate analysis, corticosteroid treatment in the 4 weeks before surgery was significantly associated with an elevated postoperative complication rate (odds ratio (95% confidence interval)=2.69 (1.15-6.29); P=0.022). Neither preoperative exposure to anti-tumor necrosis factor (TNF) agents (n=93, 44%) nor trough serum anti-TNF levels were significant risk factors for postoperative complications. In this large, nationwide, prospective cohort, postoperative complications were observed after 21% of the ileocecal resections. Corticosteroid treatment in the 4 weeks before surgery was significantly associated with an elevated postoperative complication rate. In contrast, preoperative anti-TNF therapy (regardless of the serum level or the time interval between last administration and surgery) was not associated with an elevated risk of postoperative complications.