title: Clinical recurrence and re-resection rates after extensive vs. segmental colectomy in Crohn's colitis: a retrospective cohort study.
abstract: BACKGROUND
  The aim of the present study was to document long-term clinical recurrence and re-resection rates of segmental and extended colectomy in patients with Crohn's colitis and to identify risk factors causing recurrence.
  
  
  METHODS
  Records of patients with isolated colonic Crohn's disease who underwent colectomy between 1995 and 2013 and were followed at our medical center were identified. Data on age at diagnosis, gender, smoking, disease location at diagnosis, perianal and rectal disease, indication for surgery, preoperative disease duration, type of operation, primary anastomosis at first operation, length of resected specimen, recurrence of symptoms, postoperative medication, reoperation, and total follow-up time were retrieved.
  
  
  RESULTS
  Thirty-five suitable patients (18 segmental colectomy, 17 extensive colectomy; 17 males; mean age at operation 36.6 years) were identified. Mean age at primary operation was 36 years. The mean preoperative disease duration was 121 months. Postoperative medical treatment was needed in 10 (56 %) patients undergoing segmental colectomy and in 16 (94 %) of those undergoing extensive colectomy (p = 0.01). There was longer reoperation-free survival in the segmental colectomy patient group (p = 0.02) and also a trend toward longer symptom-free survival compared to the extensive colectomy patient group (p = 0.105). There was no correlation between the length of resected bowel and recurrence. Patients operated on at a younger age did not have a higher rate of recurrence of symptoms. Shorter disease duration, smoking, and male gender were risk factors for clinical recurrence.
  
  
  CONCLUSIONS
  Segmental resection with primary anastomosis can be safely performed in patients with limited Crohn's colitis with reasonable clinical recurrence rates.
authors.affiliation: Colorectal Unit, Division of Surgery, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv Medical Center, Tel-Aviv University, 6 Weizman Street, 6423906, Tel-Aviv, Israel.
authors.forename: M
authors.initials: M
authors.lastname: Handler
authors.affiliation: IBD Center, Department of Gastroenterology and Liver Diseases, Tel-Aviv Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: I
authors.initials: I
authors.lastname: Dotan
authors.affiliation: Colorectal Unit, Division of Surgery, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv Medical Center, Tel-Aviv University, 6 Weizman Street, 6423906, Tel-Aviv, Israel.
authors.forename: J M
authors.initials: JM
authors.lastname: Klausner
authors.affiliation: IBD Center, Department of Gastroenterology and Liver Diseases, Tel-Aviv Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: H
authors.initials: H
authors.lastname: Yanai
authors.affiliation: Colorectal Unit, Division of Surgery, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv Medical Center, Tel-Aviv University, 6 Weizman Street, 6423906, Tel-Aviv, Israel.
authors.forename: E
authors.initials: E
authors.lastname: Neeman
authors.affiliation: Colorectal Unit, Division of Surgery, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv Medical Center, Tel-Aviv University, 6 Weizman Street, 6423906, Tel-Aviv, Israel. hagitt@tlvmc.gov.il.
authors.forename: H
authors.initials: H
authors.lastname: Tulchinsky
mesh_terms: D000328:Adult; D003082:Colectomy / Q000009:adverse effects* / Q000379:methods; D003092:Colitis / Q000473:pathology / Q000601:surgery*; D003424:Crohn Disease / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Colectomy; Crohn’s colitis; Recurrence