A comparison of segmental vs subtotal/total colectomy for colonic Crohn's disease: a meta‐analysis

Abstract

Purpose: To evaluate differences in short‐ and long‐term outcomes of patients with colonic Crohn's disease (CD) undergoing either subtotal/total colectomy with ileorectal anastomosis (IRA) or segmental colectomy(SC).Method: Comparative studies from 1988 to 2002, of subtotal/total colectomy and IRA vs SC, were used. The study end points included surgical and overall recurrence, time to recurrence, postoperative morbidity and incidence of permanent stoma. Meta‐analytical tools were used to evaluate the study outcomes.Results: Six studies, consisting of a total of 488 patients (223‐IRA and 265‐SC) were included. Meta‐analysis suggested no significant difference between IRA and SC in recurrence of CD. Time to recurrence was longer in the IRA group by 4.4 years (95%CI, 3.1–5.8), P < 0.001. There was no difference in postoperative complications (OR = 1.4, 95%CI, 0.16–12.74) or the need for a permanent stoma between the two groups (OR = 2.75, 95%CI, 0.78–9.71). Patients with two or more colonic segments involved were associated with lower re‐operation rate in the IRA group, a difference which did not reach statistical significance (P = 0.177).Conclusions: Both procedures were equally effective as treatment options for colonic CD, however, patients in the SC group exhibited recurrence earlier than those in the IRA group. The choice of operation is dependent on the extent of colonic disease, with a trend towards better outcomes with IRA for two or more colonic segments involved.