Segmental versus total colectomy for Crohn's disease in the biologic era. Results from The SCOTCH international, multicentric study Travel Award

Background: The extent of resection in colonic Crohn's disease (cCD) is still a topic of debate.
Methods: The Segmental COlecTomy for CroHn’s disease (SCOTCH) international study analysed the prospective databases of six centres, comprising all consecutive patients operated between 2000 and 2019 with segmental(SC) or total colectomy(TC) for cCD. Primary aim: long-term surgical recurrence. Secondary aims: perioperative complications, stoma formation, and predictors of recurrence.
Results: Among 687 (56.2% women), SC was performed in 285 (41.5%) and TC in 402 (58.5%) patients. Mean age at diagnosis and surgery, disease duration, and follow-up were 30±15.8, 40.4±15.4, 10.4±8.6, 7.1±5.2 years. Isolated cCD, inflammatory pattern, perianal CD, younger age, longer disease duration, and preoperative high-risk therapy were more frequent in TC, while SC presented more small bowel locations and perforating disease, required less 90-day readmissions, and temporary and definitive stomas. Morbidity and mortality were similar. The 15-year surgical recurrence was 44% in TC and 27% in SC(p=0.006). In patients with 1-3 segments involved predictors of recurrence were the omission of biological therapy (HR 5.4), perianal disease (HR 1.9) and paediatric diagnosis (HR 2.1).
Conclusions: SC is safe and reduces stoma formation. Young age at diagnosis and perianal disease adversely affects, but postoperative biologicals therapy significantly reduces, the long-term surgical recurrence.