Abstract
PurposeCrohn’s colitis carries a risk for permanent stoma with extirpation of the rectum. We aimed to estimate the proctectomy rate and identify risk factors for proctectomy in patients with Crohn’s colitis.MethodsFor this study, we retrospectively reviewed data from consecutive patients with Crohn’s disease (CD) affecting the colon or anorectal region undergoing bowel resection in a reference colorectal centre between 2006 and 2016. The cumulative risk for proctectomy was calculated using the Kaplan-Meier curve. We used univariate and multivariate logistic regression analyses to determine independent risk factors for proctectomy. Outcomes after proctectomy concerning reoperation frequency and perineal wound healing are also described.ResultsIn total, this study included 125 patients. Proctectomy was performed in 36 patients (28.8%), of whom 14 patients (38.9%) experienced perineal wound healing problems. The rates of proctectomy were 5.6% and 32.0% 10 and 20 years after CD diagnosis, respectively. Female gender (odds ratio (OR) 3.375, 95% confidence interval (CI) 1.304–8.733, P = 0.012), disease duration (OR 1.067, 95% CI 1.011–1.126, P = 0.018) and history of perianal disease (OR 3.160, 95% CI 1.215–8.219, P = 0.018) were independent risk factors for a proctectomy procedure, whereas thiopurine medication (OR 0.170, 95% CI 0.060–0.486, P = 0.001) was an independent protective factor for proctectomy.ConclusionsThe duration of Crohn’s disease, female gender and a history of perianal disease were significant risk factors for a proctectomy procedure. Future research should examine whether immunosuppressive and biological medications reduce the risk for proctectomy.
Highlights
According to population-based studies, the incidence of Crohn’s colitis has increased in recent decades [1, 2]
We evaluated the frequency of reoperations and delayed perineal wound healing after proctectomy
A total of 125 patients with colonic or anorectal Crohn’s disease (CD) underwent bowel resection between 2006 and 2016, all of whom we included in our study
Summary
According to population-based studies, the incidence of Crohn’s colitis has increased in recent decades [1, 2]. It is estimated that more than 60% of Crohn’s disease (CD) patients have colonic involvement. Isolated Crohn’s colitis is found in 20% of patients suffering from CD, but ileocolonic involvement is more common [3]. CD of the colon or anorectal region is associated with a risk for definitive stoma requiring extirpation of the rectum. Many patients affected by this type of CD fear permanent stoma.
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