Our Summary
This research paper looks at the best way to perform surgery on patients with colonic Crohn’s disease, a type of inflammatory bowel disease that affects the colon. There’s ongoing debate on how much of the colon should be removed during surgery, considering factors like how many areas are affected, the likelihood of the disease coming back, the need for a permanent stoma (an opening in the body for waste removal), and the role of medication.
The study examined data from six major medical centers, looking at patients who had surgery between 2000 and 2019. They compared two types of surgery: segmental colectomy, where only a part of the colon is removed, and total colectomy, where the entire colon is removed.
The results showed that segmental colectomy was performed in around 42% of cases, and total colectomy in around 59%. The research indicated that total colectomy was more common in patients with more severe disease, whereas segmental colectomy was more common in patients with less severe disease and fewer affected areas.
Importantly, the study found that patients who had segmental colectomy had lower rates of needing a stoma, had fewer readmissions to hospital, and had lower rates of the disease coming back after 15 years compared to those who had a total colectomy.
However, the research also highlighted that younger patients, those with disease in more areas, and those with perianal disease (a type of Crohn’s that affects the area around the anus) were more likely to have the disease come back. On the other hand, using biological therapy (a type of medication) after surgery significantly reduced the likelihood of the disease coming back.
In summary, the study suggests that, when possible, segmental colectomy is a safer option and leads to better outcomes for patients with colonic Crohn’s disease.
FAQs
- What is the primary aim of the SCOTCH international study on colonic Crohn’s disease?
- What factors were found to increase the risk of recurrence in patients with colonic Crohn’s disease?
- What were the conclusions of the SCOTCH international study regarding segmental colectomy versus total colectomy for colonic Crohn’s disease?
Doctor’s Tip
One helpful tip a doctor might tell a patient about colectomy is to consider postoperative biological therapy to reduce the risk of long-term surgical recurrence. This can significantly improve outcomes and potentially reduce the need for additional surgeries in the future. It is important to discuss this option with your healthcare provider to determine the best treatment plan for your individual case.
Suitable For
Patients with colonic Crohn’s disease (cCD) who are recommended for colectomy typically have one or more of the following characteristics:
Isolated cCD: Patients with colonic involvement without significant small bowel disease are often recommended for colectomy.
Inflammatory pattern: Patients with a predominantly inflammatory pattern of disease may benefit from colectomy to control symptoms and prevent complications.
Perianal CD: Patients with perianal involvement in addition to colonic disease may require colectomy to improve symptoms and prevent complications.
Younger age: Younger patients with cCD may be recommended for colectomy if other medical therapies have not been effective or if there is a high risk of complications.
Longer disease duration: Patients with long-standing cCD that is refractory to medical therapy may be candidates for colectomy.
Multiple locations: Patients with involvement of multiple segments of the colon may benefit from colectomy to remove diseased tissue and reduce the risk of recurrence.
Perforating disease: Patients with perforating complications of cCD, such as fistulas or abscesses, may require colectomy to control symptoms and prevent further complications.
Overall, the decision to recommend colectomy for patients with cCD is based on a combination of factors, including disease severity, response to medical therapy, risk of complications, and patient preference.
Timeline
Before colectomy:
- Patient is diagnosed with colonic Crohn’s disease (cCD)
- Patient may undergo various medical therapies to manage symptoms and inflammation
- Patient may experience recurrent flare-ups, complications, and hospitalizations
- Surgeon may recommend colectomy due to failure of medical therapy, severe disease, or risk of complications such as bowel obstruction or perforation
After colectomy:
- Patient undergoes either segmental colectomy (SC) or total colectomy (TC)
- Recovery period in the hospital with monitoring for complications
- Potential need for temporary or permanent stoma
- Long-term follow-up to monitor for surgical recurrence
- Postoperative management may include biological therapy to reduce risk of recurrence
- Overall, colectomy can provide relief of symptoms and improve quality of life for patients with cCD.
What to Ask Your Doctor
- What are the potential risks and complications associated with a colectomy for colonic Crohn’s disease?
- How will my quality of life be affected after a colectomy?
- What is the likelihood of needing a temporary or permanent stoma after the surgery?
- Will I still need to take medication for my Crohn’s disease after the colectomy?
- What is the long-term outlook for surgical recurrence after a colectomy for colonic Crohn’s disease?
- How will my diet and lifestyle need to change after the surgery?
- Are there any alternative treatment options to consider before proceeding with a colectomy?
- How experienced are you in performing colectomies for colonic Crohn’s disease?
- What is the typical recovery time and rehabilitation process after a colectomy?
- Are there any specific follow-up appointments or monitoring that will be needed after the surgery?
Reference
Authors: Pellino G, Rottoli M, Mineccia M, Frontali A, Celentano V, Colombo F, Baldi C, Ardizzone S, Martí Gallostra M, Espín-Basany E, Ferrero A, Panis Y, Poggioli G, Sampietro GM. Journal: J Crohns Colitis. 2022 Dec 5;16(12):1853-1861. doi: 10.1093/ecco-jcc/jjac096. PMID: 35819368