Segmental colectomy is a safe and feasible surgical option for some patients with colonic Crohn’s disease (cCD), according to a study published in the Journal of Crohns and Colitis.¹

The Segmental COlecTomy for CroHns disease (SCOTCH) study retrospectively analysed data of all patients who underwent segmental or total colectomy for cCD between 2000 and 2019 at six European tertiary centers. Out of the 687 patients included in the study, 285 (41.5%) underwent segmental colectomy (resection of 1–3 segments), while 402 (58.5%) had total colectomy (resection of 4-5 segments). The secondary objectives of the study were to assess perioperative complications, stoma formation and predictors of recurrence. The duration of disease was 10.4 years (mean). Patients with a history of bowel resection or those with colorectal cancer were not included in the study.

The long-term cumulative recurrence rate at 15 years after the surgery, which was the primary aim of the study, was 27% for patients with segmental colectomy and 44% among those who had total colectomy. Omission of biological therapy was associated with increased risk of recurrence in patients with involvement of 1 to 3 segments with hazard ratio of 5.6. The number of segments involved also correlated with recurrence risk with HR of 2.5. The hazard ratio for early age diagnosis was 2.8. Patients who underwent total colectomy were younger in age and had had their disease for a longer duration (11.3 vs 9.2 years). Inflammatory disease, current (37.8% vs 16.5%) or previous (56% vs 32.6%) perianal Crohn’s disease were found more often in this group.

Small bowel disease and perforations occurred frequently in patients who underwent segmental colectomy. But total colectomy patients more often required stomas, both temporary  (31.6% vs 21.4%) and definitive (39.3 vs 8%) and re-hospitalization at 90 days (6% vs 2.1%). No between-group differences were noted for postoperative morbidity and mortality.

The SCOTCH study has shown that compared to total colectomy, segmental colectomy was a safer procedure for patients with colonic Crohn’s disease and also reduced the need for stomas. The number of segments affected, younger age and perianal disease were predictors for disease recurrence, while administration of postoperative biologics significantly reduced risk of recurrence. These findings will help individualize treatment. The decision to opt for either segmental or total colectomy depends on the extent of the disease but it should be made after taking informed consent from the patient.

Reference

1. Gianluca Pellino, et al. Segmental versus total colectomy for Crohns disease in the biologic era. Results from The SCOTCH international, multicentric study. J Crohns Colitis. 2022 Jul 12;jjac096. doi: 10.1093/ecco-jcc/jjac096.