Prognostic factors associated with unhealed perineal wounds post-proctectomy for perianal Crohn's disease: a two-centre study.
biologics
panproctocolectomy
perianal Crohn's disease
perineal wound healing
proctectomy
surgery
Journal
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland
ISSN: 1463-1318
Titre abrégé: Colorectal Dis
Pays: England
ID NLM: 100883611
Informations de publication
Date de publication:
Aug 2021
Aug 2021
Historique:
revised:
11
03
2021
received:
18
12
2020
accepted:
13
05
2021
pubmed:
23
5
2021
medline:
16
9
2021
entrez:
22
5
2021
Statut:
ppublish
Résumé
The aim of this work was to determine the factors associated with poor wound healing in patients with perianal Crohn's disease (pCD) who had undergone proctectomy in the era of biologic therapies. Case record review was performed on 103 patients with pCD who underwent proctectomy at St Mark's Hospital, Harrow and the Western General Hospital, Edinburgh between 2005 and 2017. Healing rates at 6 and 12 months post-proctectomy were considered; univariate analysis was performed. Sixty out of 103 patients (58.3%) had failure of wound healing at 6 months and 41/103 (39.8%) at 12 months. In total, 63.1% (65/103) patients received biologic therapies prior to proctectomy; however, exposure to biologics was not a significant factor in predicting failure of wound healing at 12 months (infliximab p = 0.255; adalimumab p = 0.889; vedolizumab p = 0.153). Male gender was the only variable associated with poor wound healing at 12 months on univariate analysis (p = 0.017). A lower pre-operative C-reactive protein was associated with early wound healing at 6 months compared with at 12 months (p = 0.041) on univariate analysis. Other parameters not associated with rates of wound healing included smoking status, corticosteroid exposure, thiopurine exposure, number of previous biologics, perianal sepsis on MRI within the last 12 months, duration of CD prior to proctectomy and pre-operative albumin. More than a third of patients had unhealed wounds 12 months after proctectomy. We report that unhealed wounds are more common in male patients. Importantly, our results also suggest that exposure to biologics does not affect rates of wound healing.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2091-2099Informations de copyright
© 2021 The Association of Coloproctology of Great Britain and Ireland.
Références
Schwartz DA, Loftus EV, Tremaine WJ, Panaccione R, Harmsen WS, Zinsmeister AR, et al. The natural history of fistulizing Crohn’s disease in Olmsted County, Minnesota. Gastroenterology. 2002;122(4):875-80.
Hellers G, Bergstrand O, Ewerth S, Holmström B. Occurrence and outcome after primary treatment of anal fistulae in Crohn’s disease. Gut. 1980;21(6):525-7.
Williams DR, Coller JA, Corman ML, Warren Nugent F, Veidenheimer MC. Anal complications in Crohn’s disease. Dis Colon Rectum. 1981;24(1):22-4.
Sands BE, Anderson FH, Bernstein CN, Chey WY, Feagan BG, Fedorak RN, et al. Infliximab maintenance therapy for fistulizing Crohn’s disease. N Engl J Med. 2004;350:876-85.
Panés J, García-Olmo D, Van Assche G, Colombel JF, Reinish W, Baumgart DC, et al. Long-term efficacy and safety of stem cell therapy (Cx601) for complex perianal fistulas in patients with Crohn's disease. Gastroenterology. 2018;154(5):1334-1342.e4.
Genue JC, Vivas DA. Management of nonhealing perineal wounds. Clinic Colon Rectal Surg. 2007;20(4):322-8.
Yamamoto T, Bain IM, Allan RN, Keighley MRB. Persistent perineal sinus after proctocolectomy for Crohn’s disease. Dis Colon Rectum. 1999;42(1):96-101.
Broader JH, Masselink BA, Oates GD, Alexander-Williams J. Management of the pelvic space after proctectomy. Br J Surg. 1974;61:94-7.
Scammel BE, Keighley MRB. Delayed perineal wound healing after proctectomy for Crohn’s disease. Br J Surg. 1986;73:150-2.
Watts JM, de Dombal FT, Goligher JC. Long-term complications and prognosis following major surgery for ulcerative colitis. Br J Surg. 1966;53:1013-23.
Jalan KN, Smith AN, Ruckley CV, Falconer CWA, Small WP, Prescott RJ. Perineal wound healing in ulcerative colitis. Br J Surg. 1969;56:749-53.
De Dombal FT, Burton I, Goligher JC. The early and late results of surgical treatment for Crohn’s disease. Br J Surg. 1971;58:805-40.
Marks CG, Ritchie JK, Todd IP, Wadsworth J. Primary suture of the perineal wound following rectal excision for inflammatory bowel disease. Br J Surg. 1978;65:560-4.
Ip B, Jones M, Bassett P, Phillips R. Factors affecting the healing of the perineum following surgery. Ann R Coll Surg Engl. 2013;95:252-7.
Lennard-Jones JE. Classification of inflammatory bowel disease. Scand J Gastroenterol Suppl. 1989;170:2-6; discussion 16-9.
Corman ML, Veidenheimer MC, Coller JA, Ross VH. Perineal wound healing after proctectomy for inflammatory bowel disease. Dis Colon Rectum. 1978;21(3):155-9.
Fimmel S, Zouboulis CC. Influence of physiological androgen levels on wound healing and immune status in men. Aging Male. 2005;8(3/4):166-74.
Gilliver SC, Ruckshanthi JPD, Hardman MJ, Nakayama T, Ashcroft GS. Sex dimorphism in wound healing: the roles of sex steroids and macrophage migration inhibitory factor. Endocrinology. 2008;149(11):5747-57.
Althumairi AA, Canner JK, Gearhart SL, Safar B, Sacks Justin, Efron JE. Predictors of perineal wound complications and prolonged time to perineal wound healing after abdominoperineal resection. World J Surg. 2016;40:1755-62.
Chang C-C, Lan Y-T, Jiang J-K, Chang S-C, Yang S-H, Lin C-C, et al. Risk factors for delayed perineal wound healing and its impact on prolonged hospital stay after abdominoperineal resection. World J Surg Oncol. 2019;17(1):226.
Régimbeau JM, Panis Y, Cazaban L, Pocard M, Bouhnik Y, Matuchansky C, et al. Long-term results of faecal diversion for refractory perianal Crohn’s disease. Colorectal Dis. 2001;3(4):232-7.
Hong MKH, Lynch AC, Bell S, Woods RJ, Keck JO, Johnston MJ, et al. Faecal diversion in the management of perianal Crohn’s disease. Colorectal Dis. 2011;13(2):171-6.
Gu J, Valente MA, Remzi FH, Stocchi L. Factors affecting the fate of faecal diversion in patients with perianal Crohn’s disease. Colorectal Dis. 2015;17(1):66-72.
Yamamoto T, Allan RN, Keighley MRB. Effect of fecal diversion alone on perianal Crohn’s disease. World J Surg. 2000;24:1258-63.
Singh S, Ding NS, Mathis KL, Dulai PS, Farrell AM, Pemberton JH, et al. Systematic review and meta-analysis: faecal diversion for management of perianal Crohn’s disease. Aliment Pharmacol Ther. 2015;42(7):783-92.
El-Hussuna A, Krag A, Olaison G, Bendtsen F, Gluud LL. The effect of anti-tumour necrosis factor alpha agents on postoperative anastomotic complications in Crohn’s disease: a systematic review. Dis Colon Rectum. 2013;56:1423-33.
Schleier L, Wiendl M, Heidbreder K, Binder M-T, Atreya R, Rath T, et al. Non-classical monocyte homing to the gut via α4β7 integrin mediates macrophage-dependent intestinal wound healing. Gut. 2020;69:252-63.
Yu H, MacIsaac D, Wong JJ, Sellers ZM, Wren AA, Bensen R, et al. Market share and costs of biologic therapies for inflammatory bowel disease in the USA. Aliment Pharmacol Ther. 2018;47:364-70.
de Groof EJ, van der Meer JHM, Tanis PJ, de Bruyn JR, van Ruler O, D’Haens GRAM, et al. Persistent mesorectal inflammatory activity is associated with complications after proctectomy in Crohn’s disease. J Crohn’s Colitis. 2019;13(3):285-93.