A systematic review of segmental vs subtotal colectomy and subtotal colectomy vs total proctocolectomy for colonic Crohn's disease

Aim Surgical management of colonic Crohn's disease (CD) is still unclear because different procedures can be adopted. The choice of operation is dependent on the involvement of colonic disease but the advantages and disadvantages of the extent of resection are still debated. Method The aim of t...

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Bibliographic Details
Published in:Colorectal disease 2017-08, Vol.19 (8), p.e279-e287
Main Authors: Angriman, I., Pirozzolo, G., Bardini, R., Cavallin, F., Castoro, C., Scarpa, M.
Format: Article
Language:English
Subjects:
Adult
Anastomosis
Anastomosis, Surgical - statistics & numerical data
Colectomy - adverse effects
Colectomy - methods
Colon
Colon - pathology
Colon - surgery
Colostomy - statistics & numerical data
Complications
Crohn Disease - pathology
Crohn Disease - surgery
Crohn's disease
Crohns disease
Data processing
Female
Humans
ileorectal anastomosis
Ileostomy
Incidence
Male
Meta-analysis
Middle Aged
Morbidity
Ostomy
Postoperative Complications - etiology
Proctocolectomy, Restorative - adverse effects
Proctocolectomy, Restorative - methods
Recurrence
Risk Factors
segmental resection
subtotal colectomy
Treatment Outcome
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Summary:Aim Surgical management of colonic Crohn's disease (CD) is still unclear because different procedures can be adopted. The choice of operation is dependent on the involvement of colonic disease but the advantages and disadvantages of the extent of resection are still debated. Method The aim of the present study was to evaluate the differences in short‐term and long‐term outcomes of adult patients with colonic CD who underwent either subtotal colectomy and ileorectal anastomosis (STC) or segmental colectomy (SC) or total proctocolectomy and end ileostomy (TPC). Studies published between 1984 and 2012 including comparisons of STC vs SC and of STC vs TPC were selected. The study end‐points were overall and surgical recurrence, postoperative morbidity and incidence of permanent stoma. Fixed effect models were used to evaluate the study outcomes. Results Eleven studies, consisting of a total of 1436 patients (510 STC, 500 SC and 426 TPC), were included. Analysis of the data showed no significant difference between STC and SC in terms of overall and surgical recurrence of CD. In contrast, STC showed a higher risk of overall and surgical recurrence of CD than TPC (OR 3.53, 95% CI 2.45–5.10, P 
ISSN:1462-8910
1463-1318
DOI:10.1111/codi.13769