NEUROFARBA Department, Pharmacology and Toxicology Section, University of Florence, Florence, Italy.
Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy.
Langenbecks Arch Surg. 2022 Nov;407(7):2987-2996. doi: 10.1007/s00423-022-02613-6. Epub 2022 Jul 25.
The Montreal classification for Crohn's disease includes "age at diagnosis" as a parameter but few is reported about the age at surgery. The aim of this study is to evaluate the short- and long-term differences in the postoperative surgical outcome and disease behaviour, according to the age at the first surgery.
Patients consecutively operated for abdominal Crohn's disease during the period 1986-2012 at our centre were systematically analysed according to their age at first surgery. In our retrospective cohort, the age at first surgery ranged from 13 to 83 years, and patients were arbitrarily divided into four groups: ≤ 19 (G1), 20-39 (G2), 40-59 (G3) and ≥ 60 (G4) years old.
In total, 1051 patients were included with a median follow-up time of 232 months. The four groups exhibited statistically significant differences in age at diagnosis, smoke habit, time between diagnosis and surgery, disease location and behaviour, history of perianal fistula or abscess, severe malnutrition requiring total parental nutrition before surgery, type of surgery, total length of resected bowel, median duration of hospitalization, incidence of abdominal recurrences and number of surgical recurrences. G1 displays an inverse linear trend with time in the severity of clinical characteristics when compared to G4 groups. On the contrary, the incidence of short-term complications, types of abdominal recurrence and presence of concomitant perianal disease did not vary among groups. In addition, at multivariate analysis, the age at surgery and the disease location were the only independent risk factors for abdominal surgical recurrence.
Despite first surgery is extremely more frequent between 20 and 59 years, patients from G1 and G4 groups showed clinical differences and peculiarities when compared to the other age groups. The most indolent CD behaviour and occurrence of surgical recurrence was observed in patients having their first abdominal surgery in the elderly, while patients operated before the age of 19 experienced a more aggressive disease course.
克罗恩病的蒙特利尔分类包括“诊断时的年龄”作为一个参数，但很少有关于手术时年龄的报道。本研究旨在评估根据首次手术时的年龄，术后手术结果和疾病行为的短期和长期差异。
我们中心在 1986 年至 2012 年期间对连续接受腹部克罗恩病手术的患者进行了系统分析，根据他们首次手术时的年龄进行分类。在我们的回顾性队列中，首次手术年龄从 13 岁到 83 岁不等，患者被分为四组：≤19 岁（G1 组）、20-39 岁（G2 组）、40-59 岁（G3 组）和≥60 岁（G4 组）。
共纳入 1051 例患者，中位随访时间为 232 个月。四组在诊断时的年龄、吸烟习惯、诊断与手术之间的时间、疾病部位和行为、肛周瘘管或脓肿史、术前严重营养不良需要全胃肠外营养、手术类型、切除肠段总长度、中位住院时间、腹部复发发生率和手术复发次数方面存在统计学显著差异。与 G4 组相比，G1 组的临床特征严重程度呈反线性趋势。相反，短期并发症、腹部复发类型和伴发肛周疾病的发生率在各组之间没有差异。此外，在多变量分析中，手术年龄和疾病部位是腹部手术复发的唯一独立危险因素。
尽管 20-59 岁之间首次手术极为频繁，但与其他年龄组相比，G1 组和 G4 组的患者存在临床差异和特点。在老年患者中，首次腹部手术的患者发生的 CD 行为最惰性，手术复发的发生率最高，而 19 岁以下接受手术的患者疾病进展更为激进。
