Carvello Michele, Maroli Annalisa, Wickramasinghe Dakshita, Di Candido Francesca, Dal Buono Arianna, Armuzzi Alessandro, Warusavitarne Janindra, Spinelli Antonino
Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4Pieve Emanuele, 20090, Milan, Italy.
Division of Colon and Rectal Surgery, IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56Rozzano, 20089, Milan, Italy.
Updates Surg. 2025 Apr 23. doi: 10.1007/s13304-025-02171-8.
This study aims to identify risk factors of conversion to open surgery for patients undergoing minimally invasive surgery for their CD and to develop a predictive scoring system. Data from patients undergoing minimally invasive resection for their CD were collected in two European referral centers. The scoring system was developed from a logistic regression model including clinical and operative variables and its performance was evaluated using receiver operating characteristics (ROC) area under the curve (AUC). The study included 309 patients including surgery for recurrence. Conversion to open surgery occurred in 21% (65/309) of patients. The logistic regression analysis identified male sex, BMI, preoperative evidence of multiple disease localizations and abscess or perforation, and previous surgery for CD as independent risk factors for conversion. The risk score values in the converted group were significantly higher compared to non-converted group (MD = - 20.40; 95%CI - 14.12 to - 26.69; p < 0.0001). In the ROC analysis, the score achieved an AUC of 0.80 (SE = 0.03; 95%CI 0.74-0.86; p < 0.0001). Male sex, BMI, preoperative evidence of multiple disease localizations and abscess or perforation, and previous surgery for CD were associated with an increased risk of conversion to open surgical approach in patients undergoing minimally invasive surgery and were used to develop a predictive score. The results of this study might be useful to tailor patient expectations and perioperative pain management in ileocecal resection for Crohn's disease.
本研究旨在确定接受克罗恩病（CD）微创手术的患者转为开放手术的风险因素，并开发一种预测评分系统。在两个欧洲转诊中心收集了接受CD微创手术患者的数据。该评分系统由一个包含临床和手术变量的逻辑回归模型开发而来，其性能使用受试者工作特征（ROC）曲线下面积（AUC）进行评估。该研究纳入了309例患者，包括复发性手术患者。21%（65/309）的患者转为开放手术。逻辑回归分析确定男性、体重指数（BMI）、术前存在多种病变部位以及脓肿或穿孔，以及既往CD手术史为转为开放手术的独立风险因素。与未转换组相比，转换组的风险评分值显著更高（MD = -20.40；95%CI -14.12至-26.69；p < 0.0001）。在ROC分析中，该评分的AUC为0.80（SE = 0.03；95%CI 0.74 - 0.86；p < 0.0001）。男性、BMI、术前存在多种病变部位以及脓肿或穿孔，以及既往CD手术史与接受微创手术的患者转为开放手术方法的风险增加相关，并用于开发预测评分。本研究结果可能有助于调整患者预期以及克罗恩病回盲部切除术中的围手术期疼痛管理。
