Document Detail

Surgical treatment of anoperineal Crohn's disease: can abdominoperineal resection be predicted?
MedLine Citation:
PMID:  10437839     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Anoperineal Crohn's disease (APCD) runs an unpredictable course. Although this course is relatively benign in most patients, some will eventually require abdominoperineal resection (APR). The aim of this study was to identify prognostic factors of longterm APR in patients with APCD. STUDY DESIGN: From 1980 to 1996, 119 patients were operated on for APCD (mean +/- SD age 30 +/- 13 years; range 11 to 96 years). Patients were divided into two groups: those undergoing APR and patients without APR at the end of followup. The following prognostic criteria were studied: (1) age at onset of Crohn's disease (CD) and at the first manifestation of APCD, gender, APCD as the first manifestation of CD, and interval between the onset of CD and the first manifestation of APCD; (2) for the first manifestation of APCD, the type and number of lesions and the results of surgical treatment; and (3) associated intestinal localizations of CD and the type and number of manifestations of APCD during followup. RESULTS: Mean followup from the first manifestation of APCD was 93 months (range 1 to 398 months). At the end of followup, 30 patients had undergone APR (25%). Logistic regression analysis showed that four criteria seemed to be associated with an increased risk of APR: age at first APCD (p < 0.02), fistula as the first manifestation of APCD (p < 0.04), more than three APCD lesions during followup (p < 0.01), and rectal involvement by CD (p < 0.000001). When, as in eight patients, these criteria were all present, APR was performed during followup in 100% of patients. In the absence of all four criteria (eight patients), APR was never performed. CONCLUSIONS: This study allowed us to identify patients with APCD at high risk of APR. For these patients, early prevention of CD recurrence should be attempted by aggressive medical therapy.
J M Régimbeau; Y Panis; P Marteau; S Benoist; P Valleur
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the American College of Surgeons     Volume:  189     ISSN:  1072-7515     ISO Abbreviation:  J. Am. Coll. Surg.     Publication Date:  1999 Aug 
Date Detail:
Created Date:  1999-08-12     Completed Date:  1999-08-12     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9431305     Medline TA:  J Am Coll Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  171-6     Citation Subset:  AIM; IM    
Department of Surgery, Lariboisière Hospital, Paris, France.
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MeSH Terms
Aged, 80 and over
Anus Diseases / diagnosis,  surgery*
Crohn Disease / diagnosis,  surgery*
Follow-Up Studies
Middle Aged
Postoperative Complications / diagnosis,  surgery
Proctocolectomy, Restorative
Rectal Diseases / diagnosis,  surgery*

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