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AIM: Recent evidence challenges the current standard of offering surgery to patients with ileocaecal Crohn's disease (CD) only when they present complications of the disease. The aim of this study was to compare short-term results of patients who underwent primary ileocaecal resection for either inflammatory (luminal disease, earlier in the disease course) or complicated phenotypes, hypothesizing that the latter would be associated with worse postoperative outcomes. METHOD: A retrospective, multicentre comparative analysis was performed including patients operated on for primary ileocaecal CD at 12 referral centres. Patients were divided into two groups according to indication of surgery for inflammatory (ICD) or complicated (CCD) phenotype. Short-term results were compared. RESULTS: A total of 2013 patients were included, with 291 (14.5%) in the ICD group. No differences were found between the groups in time from diagnosis to surgery. CCD patients had higher rates of low body mass index, anaemia (40.9% vs. 27%, p < 0.001) and low albumin (11.3% vs. 2.6%, p < 0.001). CCD patients had longer operations, lower rates of laparoscopic approach (84.3% vs. 93.1%, p = 0.001) and higher conversion rates (9.3% vs. 1.9%, p < 0.001). CCD patients had a longer hospital stay and higher postoperative complication rates (26.1% vs. 21.3%, p = 0.083). Anastomotic leakage and reoperations were also more frequent in this group. More patients in the CCD group required an extended bowel resection (14.1% vs. 8.3%, p: 0.017). In multivariate analysis, CCD was associated with prolonged surgery (OR 3.44, p = 0.001) and the requirement for multiple intraoperative procedures (OR 8.39, p = 0.030). CONCLUSION: Indication for surgery in patients who present with an inflammatory phenotype of CD was associated with better outcomes compared with patients operated on for complications of the disease. There was no difference between groups in time from diagnosis to surgery.
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BACKGROUND: Surgical management for patients with inflammatory ileocecal Crohn's disease (CD) could be a reasonable alternative to second-line medical treatment. AIM: To assess short and long-term outcomes of patients operated on for inflammatory, ileocecal Crohn's disease. METHODS: A retrospective analysis of patients intervened at four referral hospitals during 2012-2021 was performed. RESULTS: 211 patients were included. 43% of patients underwent surgery more than 5 years after diagnosis, and 49% had been exposed to at least one biologic agent preoperatively. 89% were operated by laparoscopy, with 1.6% conversion rate. The median length of the resected bowel was 25 cm (7-92) and three patients (1.43%) received a stoma. Median follow-up was 36 (17-70) months. The endoscopic recurrence-free survival proportion at 24, 48, 72, 96, and 120 months was 56%, 52%, 45%, 38%, and 33%, respectively. The clinical recurrence-free survival proportion at 24, 48, 72, 96, and 120 months was 83%, 79%, 76%, 74%, and 74%, respectively. In multivariate analysis, previous biological treatment (HR=2.01; p = 0.001) was associated with a higher risk of overall recurrence. CONCLUSION: Surgery in patients with primary inflammatory ileocecal CD is associated with good postoperative outcomes, low postoperative morbidity with reasonable recurrence rates.
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BACKGROUND: Despite reductions in surgical rates that have been observed with earlier use of biological therapy, surgery still constitutes an important tool in the therapeutic armamentarium in Crohn's disease (CD), particularly in patients with stenotic and penetrating phenotypes. In these scenarios, early surgical intervention is recommended, as bowel damage is present and irreversible, leading to lower efficacy with biologics. SUMMARY: The concept of early surgery in CD supposes the possible advantages of better surgical outcomes in luminal CD after initial resection. Optimal timing of surgical intervention is associated with better postoperative outcomes, whilst delays can lead to more technically difficult and extensive procedures, which may result in an increase in postoperative complication rates and higher rates of stoma formation. Furthermore, data from the LIR!C trial have demonstrated that early surgery in luminal localized inflammatory ileocecal CD is an adequate alternative to medical therapy, with lower societal costs in the long term. In this review, we discuss the position of early resection in ileocecal CD by critically reviewing available data, describing the ideal patients to be considered for early surgery, and weighing the potential advantages and disadvantages of an early surgery paradigm. KEY MESSAGES: While early surgery may not be the right choice for every patient, the ultimate decision regarding whether surgical or medical therapy should come first in the treatment paradigm must be individualized for each patient based on the disease characteristics, phenotype, risk factors, and personal preference. This highlights the importance of the multidisciplinary team, which remains a key pillar in deciding the overall management plan for patients with CD.
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Introdução: o contexto de pandemia instaurada pelo SARS-CoV-2 acarretou um cenário de isolamento social, dificultando a prática de atividade física regular. Somado a isso, os estudantes de Medicina ainda possuem uma carga horária sobrecarregada. O objetivo do trabalho foi conhecer a qualidade de vida e a prevalência da prática de atividade física e seus efeitos durante o período de pandemia em acadêmicos de Medicina. Métodos: estudo observacional transversal realizado a partir da aplicação do questionário "Prática de atividade física por acadêmicos de Medicina durante a pandemia" em 286 estudantes de ambos os sexos, de todos os períodos de uma faculdade. Resultados: notou-se que os participantes, cursando Medicina com ensino remoto, que tinham mais motivação e tempo livre praticavam mais atividade física, enquanto os participantes que tinham menos motivação e tempo livre diminuíram a prática no período analisado. Discussão: Os estudantes compreendem que a prática de atividade física é benéfica, mesmo ela sendo impedida por cargas horárias extenuantes, até mesmo devido à educação que recebem durante a graduação. Conclusão: constatou-se que acadêmicos de Medicina que possuem aulas de educação remota durante o período estabelecido de isolamento social, consideraram apresentar mais tempo livre para a prática de atividade física. Entretanto, nem todos dedicaram esse tempo para a realização de exercícios [au]
Introduction: the context of the SARS-CoV-2 pandemic led to a scenario of social isolation, hindering the practice of regular physical activity. In addition, medical students still have a very high workload. The objective of this study was to assess the quality of life and the prevalence of physical activity and its effects among medical students during the pandemic period. Methods: cross-sectional observational study conducted through the application of the questionnaire "Engagement in physical activity among medical students during the pandemic" in 286 students of both genders, from all course periods. Results: it was found that the participants on remote medical training who had more motivation and free time exercised more, while the participants who had less motivation and free time decreased their practice of exercises in the analyzed period. Discussion: Students understand that physical activity is beneficial, even though it is hindered by strenuous workloads, due to the education they receive in the course. Conclusion: it was found that medical students who had remote classes during the period of social isolation considered they had more free time for the practice of exercises. However, not all of the dedicated this time to physical activity [au]