Department of Colon and Rectal Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea.
Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea.
World J Gastroenterol. 2021 Nov 7;27(41):7159-7172. doi: 10.3748/wjg.v27.i41.7159.
Laparoscopic ileocolic resection (LICR) is the preferred surgical approach for primary ileocolic Crohn's disease (CD) because it has greater recovery benefits than open ICR (OICR).
To compare short- and long-term outcomes in patients who underwent LICR and OICR.
Patients who underwent ICR for primary CD from 2006 to 2017 at a single tertiary center specializing in CD were included. Patients who underwent LICR and OICR were subjected to propensity-score matching analysis. Patients were propensity-score matched 1:1 by factors potentially associated with 30-d perioperative morbidity. These included demographic characteristics and disease- and treatment-related variables. Factors were compared using univariate and multivariate analyses. Long-term surgical recurrence-free survival (SRFS) in the two groups was determined by the Kaplan-Meier method and compared by the log-rank test.
During the study period, 348 patients underwent ICR, 211 by the open approach and 137 laparoscopically. Propensity-score matching yielded 102 pairs of patients. The rate of postoperative complication was significantly lower (14% 32%, = 0.003), postoperative hospital stay significantly shorter (8 d 13 d, = 0.003), and postoperative pain on day 7 significantly lower (1.4 2.3, < 0.001) in propensity-score matched patients who underwent LICR than in those who underwent OICR. Multivariate analysis showed that postoperative complications were significantly associated with preoperative treatment with biologics [odds ratio (OR): 3.14, = 0.01] and an open approach to surgery (OR: 2.86, = 0.005). The 5- and 10-year SRFS rates in the matched pairs were 92.9% and 83.3%, respectively, with SRFS rates not differing significantly between the OICR and LICR groups. The performance of additional procedures was an independent risk factor for surgical recurrence [hazard ratio (HR): 3.28, = 0.02].
LICR yielded better short-term outcomes and postoperative recovery than OICR, with no differences in long-term outcomes. LICR may provide greater benefits in selected patients with primary CD.
腹腔镜回结肠切除术（LICR）是治疗原发性回结肠克罗恩病（CD）的首选手术方法，因为它比开放回结肠切除术（OICR）具有更大的康复优势。
比较接受 LICR 和 OICR 治疗的患者的短期和长期结果。
纳入 2006 年至 2017 年在一家专门治疗 CD 的三级中心接受 ICR 治疗的原发性 CD 患者。对接受 LICR 和 OICR 的患者进行倾向评分匹配分析。通过潜在与 30 天围手术期发病率相关的因素对患者进行 1:1 的倾向评分匹配。这些因素包括人口统计学特征、疾病和治疗相关变量。使用单因素和多因素分析比较这些因素。通过 Kaplan-Meier 方法确定两组患者的长期无手术复发生存率（SRFS），并通过对数秩检验进行比较。
研究期间，348 例患者接受了 ICR 治疗，其中 211 例采用开放方法，137 例采用腹腔镜方法。倾向评分匹配产生了 102 对患者。接受 LICR 治疗的患者术后并发症发生率显著降低（14%比 32%， = 0.003），术后住院时间显著缩短（8 天比 13 天， = 0.003），术后第 7 天疼痛评分显著降低（1.4 比 2.3， < 0.001）。多因素分析显示，术前接受生物制剂治疗（比值比[OR]：3.14， = 0.01）和手术采用开放方式（OR：2.86， = 0.005）与术后并发症显著相关。匹配对的 5 年和 10 年 SRFS 率分别为 92.9%和 83.3%，OICR 和 LICR 组之间的 SRFS 率无显著差异。附加手术的执行是手术复发的独立危险因素（风险比[HR]：3.28， = 0.02）。
与 OICR 相比，LICR 具有更好的短期结果和术后恢复，长期结果无差异。在选择的原发性 CD 患者中，LICR 可能会带来更大的益处。
