Segmental colectomy beneficial over total colectomy in Chrohn’s disease

Segmental colectomy (SC) was not associated with an increased risk of surgical recurrence compared with total colectomy (TC) in participants with Crohn’s disease (CD). In addition, SC did reduce the risk of a temporary or permanent stoma. The large-scale, international, multicentre SCOTCH study adds high-quality data to the understanding of colectomy in CD.

According to existing guidelines, SC is appropriate in patients with a single involved colonic segment. However, data on SC and TC in patients with CD and multiple involved colonic segments is limited and of low quality, according to Dr Gianluca Pellino (University of Campania Luigi Vanvitelli, Italy) [1]. Therefore, the current SCOTCH trial aimed to compare the surgical recurrence rates, perioperative complications, and stoma formation rates of SC and TC in participants with primary, colonic CD (n=687). SC was defined as the resection of 1–3 segments, whereas TC involved the resection of >3 segments.

The surgical recurrence rate was significantly higher in participants who underwent TC compared with those who underwent SC (P=0.006). This result did not change with the number of segments involved (P=0.2). Furthermore, participants who underwent TC had an increased risk of a temporal stoma (31.6% vs 21.4%; P=0.0007) or a permanent stoma (39.3% vs 8%; P<0.0001). In addition, re-admissions occurred more frequently in participants who underwent TC (6% vs 2.1%; P=0.02).

Postoperative treatment with biologics reduced the risk of recurrence (25% vs 51%; P<0.001) in patients with 1–3 segments involved. Perioperative complications were numerically more frequently reported in the TC arm than in the SC arm but did not differ significantly (P=0.07). The rate of major complications was similar for the 2 groups (10.2% and 9.7%; P=0.9). Interestingly, not receiving biologic therapy was a significant predictor of recurrence (HR 5.4; P<0.0001). In addition, perianal CD (HR 1.9) and CD diagnosis before 18 years of age (HR 2.7) were predictive of recurrence.

Dr Pellino argued that these findings may be practice changing. “SC may be discussed in patients with limited colonic disease, younger patients, and those who do not display inflammatory extensive colitis, but rather have penetrating or structuring disease. The results clearly show the importance of biologic therapies in the setting of colectomy. To conclude, future studies should thoroughly investigate the application of SC in ulcerative colitis as well.”

1. Pellino G, et al. Segmental vs Total Colectomy for Crohn’s disease of the colon in the biologic era. Results from the SCOTCH international, multicentric study. OP12, ECCO 2022, 16­–19 February.

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Posted on 12 April 20228 April 2024