Surgical treatment of colonic Crohn’s disease: a national snapshot study
Authors:   SICCR Current status of Crohn’s disease surgery collaborative, Celentano Valerio , Pellino Gianluca , Rottoli Matteo , Poggioli Gilberto , Sica Giuseppe , Giglio Mariano Cesare , Campanelli Michela , Coco Claudio , Rizzo Gianluca , Sionne Francesco , Colombo Francesco , Sampietro Gianluca , Lamperti Giulia , Foschi Diego , Ficari Ferdinando , Vacca Ludovica , Cricchio Marta , Giudici Francesco , Selvaggi Lucio , Sciaudone Guido , Peltrini Roberto , Manfreda Andrea , Bucci Luigi , Galleano Raffaele , Ghazouani Omar , Zorcolo Luigi , Deidda Simona , Restivo Angelo , Braini Andrea , Di Candido Francesca , Sacchi Matteo , Carvello Michele , Martorana Stefania , Bordignon Giovanni , Angriman Imerio , Variola Angela , Barugola Giuliano , Di Ruscio Mirko , Tanzanu Marta , Geccherle Andrea , Tropeano Francesca Paola , Luglio Gaetano , Sasia Diego , Migliore Marco , Giuffrida Maria Carmela , Marrano Enrico , Moretto Gianluigi , Impellizzeri Harmony , Gallo Gaetano , Vescio Giuseppina , Sammarco Giuseppe , Terrosu Giovanni , Calini Giacomo , Bondurri Andrea , Maffioli Anna , Zaffaroni Gloria , Resegotti Andrea , Mistrangelo Massimiliano , Allaix Marco Ettore , Botti Fiorenzo , Prati Matteo , Boni Luigi , Perotti Serena , Mineccia Michela , Giuliani Antonio , Romano Lucia , Graziano Giorgio Maria Paolo , Pugliese Luigi , Pietrabissa Andrea , Delaini Gian Gaetano , Spinelli Antonino , Selvaggi Francesco 
Published: December 2020

Abstract
Aim
The different surgical options for patients with colonic Crohn’s disease (CD) include segmental colectomy, subtotal colectomy or proctocolectomy with end ileostomy. We present a national, multicentre study, promoted by the Italian Society of Colorectal Surgery with the aim to collect benchmark data and national variations on multidisciplinary management and postoperative outcomes of patients undergoing surgery for colonic CD.

Methods
All adult patients having elective surgery for colonic CD from June 2018 to May 2019 were eligible for participation in this retrospective study. The primary outcome measure was postoperative morbidity within 30 days of surgery.

Results
One hundred twenty-two patients were included: 55 subtotal colectomy, 30 segmental colectomy, 25 proctectomy and 12 proctocolectomy. Eighty-six patients (70.4%) were discussed at the inflammatory bowel disease (IBD) multidisciplinary team meeting (MDT) prior to surgery. This ranged from 76.6% for segmental colectomy to 60% for subtotal colectomy, 66.6% for proctocolectomy and 48% for proctectomy. The proportion of patients counselled by a stoma nurse preoperatively was 50%. Laparoscopy was associated with reduced postoperative morbidity (p = 0.017) and shorter length of hospital stay (p < 0.001), whilst pre-operative anti-TNF was associated with Dindo-Clavien ≥ 3 complications (p = 0.023) and longer in-hospital stay (p = 0.007). The main procedure performed (segmental colectomy, subtotal colectomy, proctocolectomy or proctectomy) was not associated with postoperative morbidity (p = 0.626).

Conclusions
Surgery for colonic CD has a high rate of postoperative complications. Almost a third of the patients were not preoperatively discussed at the IBD MDT, whilst the use of minimally invasive surgery for surgical treatment of colonic CD ranges from 40 to 66%.