EP728 - Completion-Colectomy Free Survival is Common after Proctectomy Alone for Perianal Crohn’s Disease

Monday, May 12, 2025

10:31 AM – 10:36 AM PT

ePoster Presenter(s)

LG

Lauren T. Gleason, MD

Colorectal Surgery Fellow
Mayo Clinic
Rochester, MN, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

Ian S. Reynolds, MB BCh BAO MCh PhD FRCSI

Fellow - Colon and Rectal Surgery
Mayo Clinic, Rochester, Minnesota
Rochester, MN, United States

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RH

Roy Hajjar, MD M.Sc. PhD

Colorectal surgery fellow
Mayo Clinic
Rochester, MN, United States

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This individual has no financial relationships with ineligible companies.
SK

Sidrah Khan, MD

CRS fellow
Mayo Clinic
rochester, MN, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
Emilio Sanchez, MD

Colorectal Surgery Fellow
Mayo Clinic
Rochester, MN, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
William R. Perry, M.B. Ch.B. M.P.H (he/him/his)

Colorectal Surgeon
Mayo Clinic
Mayo Clinic
Rochester, Minnesota, United States

All of the relevant financial relationships listed below have been mitigated.
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Kellie L. Mathis, M.D. (she/her/hers)

Professor of Surgery
Mayo Clinic
Mayo Clinic
Oronoco, Minnesota, United States

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Senior Author(s)

NM

Nicholas P. McKenna, M.D.

Assistant Professor of Surgery
Mayo Clinic
Rochester, Minnesota, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.

Lauren T. Gleason, MD: This individual has no financial relationships with ineligible companies.

Ian S. Reynolds, MB BCh BAO MCh PhD FRCSI: This individual has no financial relationships with ineligible companies.

Roy Hajjar, MD M.Sc. PhD: This individual has no financial relationships with ineligible companies.

Sidrah Khan, MD: This individual has no financial relationships with ineligible companies.

Emilio Sanchez, MD: This individual has no financial relationships with ineligible companies.

William R. Perry, M.B. Ch.B. M.P.H: This individual has no financial relationships with ineligible companies.

Kellie L. Mathis, M.D.: This individual has no relevant relationships with ineligible companies.

Nicholas P. McKenna, M.D.: This individual has no financial relationships with ineligible companies.

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Purpose/Background: Total proctocolectomy with end ileostomy is the standard recommendation for patients with refractory perianal Crohn’s disease and Crohn’s proctitis due to the concern of colonic Crohn’s recurrence if abdominoperineal resection is performed. However, proctectomy alone may be a viable option that also allows for improved quality of life with a colostomy compared to an end ileostomy. Currently, the recommendation for total proctocolectomy is based on one case series of ten patients. We hypothesized that patients with isolated perianal Crohn’s disease or Crohn’s proctitis would have high rates of colectomy free survival following proctectomy alone.

Methods/Interventions: A retrospective chart review was conducted of all patients with Crohn’s disease undergoing proctectomy between January 2006 and January 2024 at a single institution. Patient, disease, and operative characteristics were recorded. Kaplan Meier analysis was used to calculate colectomy free survival, which was defined as time from date of proctectomy to completion colectomy or to last follow up if patient did not undergo completion colectomy.

Results/Outcomes: Sixty patients were included in the cohort, of which 61.7% were female and 38.3% male. Median age at time of proctectomy was 47 (interquartile range [IQR], 30-62). Two-thirds of the proctectomies were performed via an open approach, and the rest via a minimally invasive approach. At the time of surgery, 48% of patients were on a biologic, 25% on an immunomodulator, and 10% on corticosteroids. Eight patients had no follow up beyond 60 days postoperatively. Of the remaining 52 patients, only 4 patients (7.7%) required completion colectomy for proximal colonic Crohn’s disease. Median time to completion colectomy was 880 days (IQR, 703-1,071). On Kaplan Meier survival analysis, both 5 and 10 year colectomy-free survival was 90% (95% confidence interval 75-96, FIGURE 1). Notably, after 5 years, colectomy free survival remained unchanged, indicating that completion colectomy was most likely to occur within 5 years of proctectomy.

Conclusion/Discussion: Colectomy-free survival was high among patients undergoing proctectomy for perianal Crohn’s disease. Proctectomy alone appears to be a safe and effective option for patients with perianal Crohn’s disease with proximal colonic sparing. This information is important for surgeons to consider when counseling patients on surgical options for isolated perianal Crohn’s disease.