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159
guidelines that account for the risk of synchronous and metachronous neoplasia in
patients with known neoplasia.
TPC/EI is recommended for patients with Crohn’s disease found to have
neoplasia because of the high risk for undetected synchronous and the develop-
ment of future metachronous neoplasia (evidence quality low; strong
recommendation).
References
1. Bergeron V, Vienne A, Sokol H, etal. Risk factors for neoplasia in inammatory bowel disease
patients with pancolitis. Am J Gastroenterol. 2010;105(11):2405–11.
2. Eaden JA, Abrams KR, Mayberry JF.The risk of colorectal cancer in ulcerative colitis: a meta-
analysis. Gut. 2001;48(4):526–35.
3. Canavan C, Abrams KR, Mayberry J.Meta-analysis: colorectal and small bowel cancer risk in
patients with Crohn's disease. Aliment Pharmacol Ther. 2006;23(8):1097–104.
4. Jess T, Loftus EV Jr, Velayos FS, et al. Incidence and prognosis of colorectal dysplasia in
inammatory bowel disease: a population-based study from Olmsted County, Minnesota.
Inamm Bowel Dis. 2006;12(8):669–76.
5. Friedman S, Rubin PH, Bodian C, Harpaz N, Present DH.Screening and surveillance colo-
noscopy in chronic Crohn's colitis: results of a surveillance program spanning 25 years. Clin
Gastroenterol Hepatol. 2008;6(9):993–8.. quiz 953–994
6. Ekbom A, Helmick C, Zack M, Adami HO.Increased risk of large-bowel cancer in Crohn's
disease with colonic involvement. Lancet. 1990;336(8711):357–9.
7. Jess T, Simonsen J, Jorgensen KT, Pedersen BV, Nielsen NM, Frisch M. Decreasing risk of
colorectal cancer in patients with inammatory bowel disease over 30 years. Gastroenterology.
2012;143(2):375–81.. e371; quiz e313–374
8. Kappelman MD, Farkas DK, Long MD, etal. Risk of cancer in patients with inammatory
bowel diseases: a nationwide population-based cohort study with 30 years of follow-up evalu-
ation. Clin Gastroenterol Hepatol. 2014;12(2):265–73.. e261
9. Taylor BA, Pemberton JH, Carpenter HA, etal. Dysplasia in chronic ulcerative colitis: impli-
cations for colonoscopic surveillance. Dis Colon Rectum. 1992;35(10):950–6.
10. Ullman T, Croog V, Harpaz N, Sachar D, Itzkowitz S.Progression of at low-grade dysplasia to
advanced neoplasia in patients with ulcerative colitis. Gastroenterology. 2003;125(5):1311–9.
11. Robles AI, Traverso G, Zhang M, etal. Whole-exome sequencing analyses of inammatory
bowel disease-associated colorectal cancers. Gastroenterology. 2016;150(4):931–43.
12. Yaeger R, Shah MA, Miller VA, etal. Genomic alterations observed in colitis-associated can-
cers are distinct from those found in sporadic colorectal cancers and vary by type of inamma-
tory bowel disease. Gastroenterology. 2016;151(2):278–87.. e276
13. Bernstein CN, Shanahan F, Weinstein WM.Are we telling patients the truth about surveillance
colonoscopy in ulcerative colitis? Lancet. 1994;343(8889):71–4.
14. O'Connor PM, Lapointe TK, Beck PL, Buret AG. Mechanisms by which inammation
may increase intestinal cancer risk in inammatory bowel disease. Inamm Bowel Dis.
2010;16(8):1411–20.
15. Farraye FA, Odze RD, Eaden J, et al. AGA medical position statement on the diagnosis
and management of colorectal neoplasia in inammatory bowel disease. Gastroenterology.
2010;138(2):738–45.
16. American Society for Gastrointestinal Endoscopy Standards of Practice C, Shergill AK,
Lightdale JR, etal. The role of endoscopy in inammatory bowel disease. Gastrointestinal
Endosc. 2015;81(5):1101–21.. e1101–1113
17. Annese V, Daperno M, Rutter MD, etal. European evidence based consensus for endoscopy in
inammatory bowel disease. J Crohns Colitis. 2013;7(12):982–1018.
16 Surgical Options forNeoplasia Complicating Crohn’s Disease oftheLarge Intestine
160
18. Colonoscopic Surveillance for Prevention of Colorectal Cancer in People with Ulcerative
Colitis, Crohn’s Disease or Adenomas. London 2011.
19. Strong S, Steele SR, Boutrous M, etal. Clinical practice guideline for the surgical management
of Crohn’s disease. Dis Colon Rectum. 2015;58(11):1021–36.
20. Cairns SR, Scholeeld JH, Steele RJ, et al. Guidelines for colorectal cancer screening and
surveillance in moderate and high risk groups (update from 2002). Gut. 2010;59(5):666–89.
21. Maykel JA, Hagerman G, Mellgren AF, etal. Crohn's colitis: the incidence of dysplasia and
adenocarcinoma in surgical patients. Dis Colon Rectum. 2006;49(7):950–7.
22. Kiran RP, Nisar PJ, Goldblum JR, etal. Dysplasia associated with Crohn's colitis: segmental
colectomy or more extended resection? Ann Surg. 2012;256(2):221–6.
23. Maser EA, Sachar DB, Kruse D, Harpaz N, Ullman T, Bauer JJ.High rates of metachronous
colon cancer or dysplasia after segmental resection or subtotal colectomy in Crohn's colitis.
Inamm Bowel Dis. 2013;19(9):1827–32.
24. O'Riordan JM, O'Connor BI, Huang H, etal. Long-term outcome of colectomy and ileorectal
anastomosis for Crohn's colitis. Dis Colon Rectum. 2011;54(11):1347–54.
25. Velayos F, Kathpalia P, Finlayson E. Changing paradigms in detection of dysplasia and
management of patients with inammatory bowel disease: is colectomy still necessary?
Gastroenterology. 2017;152(2):440–50.e441
26. Yamamoto T, Allan RN, Keighley MRB.Smoking is a predictive factor for outcome after colec-
tomy and ileorectal anastomosis in patients with Crohn's colitis. Br J Surg. 1999;86(8):1069–70.
27. Toh JW.Surgery for colorectal cancer in Crohn’s disease: should we perform a total procto-
colectomy for all patients with high-grade dysplasia and cancer in Crohn’s disease? Dis Colon
Rectum. 2017;60(8):e605.
28. Laine L, Kaltenbach T, Barkun A, McQuaid KR, Subramanian V, Soetikno R.SCENIC inter-
national consensus statement on surveillance and management of dysplasia in inammatory
bowel disease. Gastrointestinal Endosc. 2015;81(3):489–501.e426
29. Lichtenstein GR, Loftus EV, Isaacs KL, Regueiro MD, Gerson LB, Sands BE.ACG clinical
guideline: management of Crohn’s disease in adults. Am J Gastroenterol. 2018;113(4):481–517.
30. Krugliak Cleveland N, Colman RJ, Rodriquez D, etal. Surveillance of IBD using high de-
nition colonoscopes does not miss adenocarcinoma in patients with low-grade dysplasia.
Inamm Bowel Dis. 2016;22(3):631–7.
31. Eluri S, Parian AM, Limketkai BN, et al. Nearly a third of high-grade dysplasia and
colorectal cancer is undetected in patients with inammatory bowel disease. Dig Dis Sci.
2017;62(12):3586–93.
32. Kiran RP, Khoury W, Church JM, Lavery IC, Fazio VW, Remzi FH.Colorectal cancer com-
plicating inammatory bowel disease: similarities and differences between Crohn's and ulcer-
ative colitis based on three decades of experience. Ann Surg. 2010;252(2):330–5.
33. Lightner AL.Segmental resection versus total proctocolectomy for Crohn’s colitis: what is the
best operation in the setting of medically refractory disease or dysplasia? Inamm Bowel Dis.
2018;24(3):532–8.
34. Siegel CA, Schwartz LM, Woloshin S, etal. When should ulcerative colitis patients undergo
colectomy for dysplasia? Mismatch between patient preferences and physician recommenda-
tions. Inamm Bowel Dis. 2010;16(10):1658–62.
35. Nieminen U, Jussila A, Nordling S, Mustonen H, Farkkila MA.Inammation and disease
duration have a cumulative effect on the risk of dysplasia and carcinoma in IBD: a case-control
observational study based on registry data. Int J Cancer. 2014;134(1):189–96.
36. Soetikno RM, Lin OS, Heidenreich PA, Young HS, Blackstone MO.Increased risk of colorec-
tal neoplasia in patients with primary sclerosing cholangitis and ulcerative colitis: a meta-
analysis. Gastrointest Endosc. 2002;56(1):48–54.
J. S. Scow and A. Merchea
161
© Springer Nature Switzerland AG 2019
N. Hyman et al. (eds.), Mastery of IBD Surgery,
https://doi.org/10.1007/978-3-030-16755-4_17
L. Stocchi (*)
Division of Colorectal Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
e-mail: stocchi.luca@mayo.edu
17
The Role ofSegmental Resection
inCrohn’s Colitis
LucaStocchi
Introduction
Total abdominal colectomy with ileorectal anastomosis is an accepted alterna-
tive to total proctocolectomy and end ileostomy in the surgical management of
patients with Crohn’s disease of the colon provided that the rectum and anoper-
ineum have minimal or no evidence of active disease [1–3]. Segmental colonic
resection for the same scenario is an even more conservative option, which
could still remove gross disease while allowing improved functional results. It
is uncertain however whether a segmental resection actually results in improved
functional outcomes and whether it is associated with an increased risk of dis-
ease recurrence.
Patient population
Intervention Comparator
Outcomes studied
Patients with Crohn’s colitis
and rectal sparing
Segmental
resection
Total
colectomy
Recurrence rate,
functional results
Search Strategy
A comprehensive literature search of Cochrane Database of Collected Research,
EMBASE, MEDLINE, and PubMed was performed to identify all of the English-
language publications related to Crohn’s disease, colectomy, recurrence and func-
tional results from 1985 to 2015. Key search terms included the following: “Crohn’s
colitis”, “Crohn’s disease of the colon”, “inammatory bowel disease,” “Crohn’s
162
disease” “surgical treatment”, “colectomy,” “subtotal colectomy”, “total colec-
tomy”, “hemicolectomy”, “segmental colectomy”, “resection of the colon”, “colonic
resection”. Studies were excluded if they did not directly contrast segmental
resection with total colectomy, failed to measure recurrence and functional results,
included patients with ulcerative colitis or familial adenomatous polyposis, or
included pediatric patients. Only the most recent study was included if similar
studies from the same institution were encountered. The references of the included
studies were reviewed to identify additional studies that were incorporated as
appropriate.
Results
The available evidence indicates that segmental colectomy and total abdominal
colectomy for management of Crohn’s disease of the colon are comparable with
respect to the risk of recurrence. When assessing surgical recurrence, a few studies
have been conducted over a long period of time and their quality is moderate to low
(Table 17.1). All of the studies are retrospective and not surprisingly patients
treated with segmental colectomy were more likely to have disease localized to a
single colonic segment while total abdominal colectomy was more frequently per-
formed when two or more colonic segments were involved. An earlier meta-analy-
sis comparing these surgical approaches in patients with two or more colonic
segments indicated that patients undergoing total abdominal colectomy and ileo-
rectal anastomosis experienced a lower reoperation rate, although the difference
did not reach statistical signicance [4]. Angriman conducted a more recent sys-
tematic review, which included data on both surgical recurrence and overall
recurrence, and found statistically similar rates when comparing the two opera-
tions. An additional subset analysis that focused on patients undergoing surgery
after the introduction of biologic medications again conrmed equivalence in the
risk of either overall or surgical recurrence [5].
Table 17.1 Selected studies comparing surgical recurrence after segmental colectomy vs total
colectomy
Author
Year
Patients (N)
Segmental resection
vs. total colectomy
5-year recurrence (%)
Segmental resection
vs. total colectomy
Quality of
evidence
Sanfey [9] 1983 14 vs. 14 50 vs. 57 Low
Andrews
a
[10] 1989 36 vs. 63 26 vs. 46 Low
Bernell
b
[17] 2001 134 vs. 106 47 vs. 58 Moderate
Andersson [6] 2002 31 vs. 26 55 vs. 41 Moderate
Fichera [7] 2005 54 vs. 49 38 vs. 24 Moderate
Kiran [8] 2011 49 vs. 59 27 vs. 14 Moderate
a
Data on segmental resection refers to right hemicolectomy
b
10-year clinical recurrence instead of 5-year surgical recurrence assessed
L. Stocchi
163
With respect to functional results, one relevant endpoint assessed in the literature
is the risk of permanent stoma. Most studies have indicated that the risk for perma-
nent stoma creation is comparable between segmental colectomy and total colec-
tomy, particularly more recent studies [6–8]. Earlier studies had suggested that the
more conservative segmental colectomy is actually associated with a signicant
reduction in the risk of permanent stoma creation [9–11]. When all eligible studies
were evaluated in a systematic review, the incidence of permanent stoma was sig-
nicantly decreased following segmental colectomy [5].
Despite the putative advantages of preservation of a longer segment of function-
ing bowel, there is actually limited data on functional outcomes. Andersson reported
that patients undergoing segmental colectomy experienced improved anorectal
function when assessing a composite score incorporating the ability to pass atus
without leakage, incontinence for loose stools, and soiling [6]. A subsequent study
by Kiran assessed the Cleveland Global Quality of Life [12] instrument scores and
Short Form Inammatory Bowel Disease Questionnaire scores, which were both
found to be statistically similar between the groups [8].
The management of patients with dysplasia or cancer on the background of
Crohn’s disease is a particularly daunting problem. In general, the standard of care
in this situation is total proctocolectomy with end ileostomy and either a segmental
resection or a total colectomy should be avoided [13]. Kiran identied a 40% rate of
remote dysplasia in the resected specimen in the presence of cancer and an inci-
dence of multifocal dysplasia of 44% [14]. A more recent study reported that 40%
of patients undergoing segmental colectomy for neoplasm and 35% receiving a sub-
total colectomy for the same indication developed metachronous cancer over a
mean follow-up of 6.8years [15]. However, there have been reports of selected
patients undergoing conservative, sphincter-saving procedures, ranging from seg-
mental resection to subtotal colectomy, which resulted in acceptable oncologic out-
comes. This approach remains highly controversial and has been advocated for
individualized cases, such as poor-risk patients and/or cases of preoperative low-
grade dysplasia [14]. The techniques of endoscopic detection and management of
colorectal dysplasia in Crohn’s disease of the colon continue to evolve and could
lead in the future to a decreased number of patients requiring surgery for this par-
ticular indication [16].
Recommendations
In patients requiring surgery for Crohn’s disease of the colon, a segmental colectomy
is equivalent to a total abdominal colectomy in terms of disease recurrence and risk of
permanent stoma creation. If the extent of disease is limited, a segmental resection is
therefore preferable. While the preservation of a longer segment of functional large
intestine seems to be intuitively desirable, a segmental resection is not associated with
substantially documented advantages. For patients requiring surgery for dysplasia, the
operation of choice remains total proctocolectomy with end ileostomy.
17 The Role ofSegmental Resection inCrohn’s Colitis
164
Personal View
The general management principle describing the surgical approach to colonic dis-
ease should be to resect only segments of colon that are grossly involved with
Crohn’s disease. Therefore, if Crohn’s disease is located in a discrete segment of
colon, a segmental resection is preferable. The perioperative complication rate is
similar to total colectomy and there are possible functional advantages. There is no
evidence that the removal of a longer segment of colon through total abdominal
colectomy results in either reduced disease recurrence or increased stoma-free sur-
vival. The factors independently associated with disease recurrence and risk of per-
manent stoma creation do not include a particular restorative procedure, whether
segmental resection or total colectomy, but are instead disease-related or patient-
related variables such as younger age [18], female sex [19], and concurrent perianal
disease [8, 17]. The only operation for large bowel Crohn’s disease that indepen-
dently minimizes the risk of disease recurrence is total proctocolectomy with end
ileostomy, which is obviously not favored by the majority of patients.
In the case of diffuse Crohn’s disease of the colon with rectal sparing or mild
proctitis, total abdominal colectomy remains a reasonable surgical option. Under
these circumstances segmental colectomy is not feasible. Two segments of disease
separated by a short segment of grossly preserved colon should be de facto consid-
ered as one single area of disease and therefore should be preferentially treated with
one long, encompassing segmental resection. However, if the colitis is distributed in
two or more distinctive segments, a total abdominal colectomy is preferable to a
double segmental colonic resection.
With respect to dysplasia in the background of Crohn’s disease of the colon,
treatment algorithms are evolving with increasing data supporting the safety of
endoscopic management as suggested by the SCENIC guidelines [16]. For those
patients requiring surgery for dysplasia, any option more conservative then total
proctocolectomy and end ileostomy remains oncologically risky and should be con-
sidered only in extraordinary, individualized cases.
Abstracted Recommendation
Patients requiring surgery for Crohn’s disease of the large bowel limited to the colon
can undergo segmental resection when technically feasible instead of total abdomi-
nal colectomy. (strong recommendation based on low and moderate quality
evidence).
References
1. Longo WE, etal. Outcome of ileorectal anastomosis for Crohn's colitis. Dis Colon Rectum.
1992;35(11):1066–71.
2. Yamamoto T, Allan RN, Keighley MR.Smoking is a predictive factor for outcome after colec-
tomy and ileorectal anastomosis in patients with Crohn's colitis. Br J Surg. 1999;86(8):1069–70.
L. Stocchi
165
3. O'Riordan JM, etal. Long-term outcome of colectomy and ileorectal anastomosis for Crohn's
colitis. Dis Colon Rectum. 2011;54(11):1347–54.
4. Tekkis PP, etal. A comparison of segmental vs subtotal/total colectomy for colonic Crohn's
disease: a meta-analysis. Color Dis. 2006;8(2):82–90.
5. Angriman I, etal. A systematic review of segmental vs subtotal colectomy and subtotal colec-
tomy vs total proctocolectomy for colonic Crohn's disease. Color Dis. 2017;19(8):e279–87.
6. Andersson P, etal. Segmental resection or subtotal colectomy in Crohn's colitis? Dis Colon
Rectum. 2002;45(1):47–53.
7. Fichera A, etal. Long-term outcome of surgically treated Crohn's colitis: a prospective study.
Dis Colon Rectum. 2005;48(5):963–9.
8. Kiran RP, etal. The role of primary surgical procedure in maintaining intestinal continuity for
patients with Crohn's colitis. Ann Surg. 2011;253(6):1130–5.
9. Sanfey H, Bayless TM, Cameron JL.Crohn's disease of the colon. Is there a role for limited
resection? Am J Surg. 1984;147(1):38–42.
10. Andrews HA, Lewis P, Allan RN.Prognosis after surgery for colonic Crohn's disease. Br J
Surg. 1989;76(11):1184–90.
11. Makowiec F, et al. Long-term follow-up after resectional surgery in patients with Crohn's
disease involving the colon. Z Gastroenterol. 1998;36(8):619–24.
12. Kiran RP, et al. Prospective assessment of Cleveland Global Quality of Life (CGQL) as a
novel marker of quality of life and disease activity in Crohn's disease. Am J Gastroenterol.
2003;98(8):1783–9.
13. Strong S, etal. Clinical practice guideline for the surgical management of Crohn's disease. Dis
Colon Rectum. 2015;58(11):1021–36.
14. Kiran RP, et al. Dysplasia associated with Crohn's colitis: segmental colectomy or more
extended resection? Ann Surg. 2012;256(2):221–6.
15. Maser EA, etal. High rates of metachronous colon cancer or dysplasia after segmental resec-
tion or subtotal colectomy in Crohn's colitis. Inamm Bowel Dis. 2013;19(9):1827–32.
16. Laine L, etal. SCENIC international consensus statement on surveillance and management of
dysplasia in inammatory bowel disease. Gastroenterology. 2015;148(3):639–651.e28.
17. Bernell O, Lapidus A, Hellers G. Recurrence after colectomy in Crohn's colitis. Dis Colon
Rectum. 2001;44(5):647–54; discussion 654.
18. Martel P, etal. Crohn's colitis: experience with segmental resections; results in a series of 84
patients. J Am Coll Surg. 2002;194(4):448–53.
19. Polle SW, etal. Recurrence after segmental resection for colonic Crohn's disease. Br J Surg.
2005;92(9):1143–9.
17 The Role ofSegmental Resection inCrohn’s Colitis
167
© Springer Nature Switzerland AG 2019
N. Hyman et al. (eds.), Mastery of IBD Surgery,
https://doi.org/10.1007/978-3-030-16755-4_18
S. J. O’Brien · S. Galandiuk (*)
Price Institute of Surgical Research, The Hiram C.Polk Jr. M.D.Department of Surgery,
University of Louisville, Louisville, KY, USA
e-mail: s0gala01@louisville.edu
18
Role ofPercutaneous Drainage
forDisease-Related Abscesses
StephenJ.O’Brien andSusanGalandiuk
Introduction
Intra-abdominal abscesses can occur in up to 20% of patients with Crohn’s
disease, and the management of these abscesses is a complex issue, even for
inammatory bowel disease specialists [1, 2]. A number of treatment modalities
have been proposed to manage disease-related abscesses, including surgery, per-
cutaneous drainage (PD), conservative medical management, and various combi-
nations of these approaches. However, the relatively low incidence of this
complication provides somewhat of a barrier for prospective trial designs that aim
to identify the optimal management for disease-related abscesses. Several small
retrospective studies have attempted to describe the incidence of disease-related
abscesses and their treatment. The most appropriate management is dependent on
multiple factors including abscess size and location and interventional radiology
resource availability.
PICO table
Patient Population
Intervention Comparator
Outcomes Studied
Patients with Crohn’s
disease requiring surgery
presenting with
associated abscess
Preliminary
percutaneous
drainage
Denitive surgery Postoperative
complications, cost
effectiveness
168
Search Strategy
A literature search of the EMBASE and MEDLINE databases was conducted using
the search terms; “Crohn’s disease,” “abscess,” percutaneous drainage,” “surgery,”
“complications”, “cost-effective analysis”, “mortality”, and “morbidity.” The
Boolean operators “AND” and “OR” were used to dene the search. Articles pub-
lished from 2000 to 2018 were considered for inclusion. No language restrictions
were applied. Initially, two hundred and sixty-ve articles were identied. Following
removal of duplicate articles, conference abstracts, case reports, and pediatric
papers, 160 abstracts were screened. Forty-ve full texts were analyzed and only
articles which directly compared the role of PD versus surgery or “PD plus surgery”
versus “surgery alone” were included in analysis below. This included 8 observa-
tional studies and 2 meta-analyses. The specic outcomes of interest were those that
pertained to post-procedural complications and cost-effectiveness in the manage-
ment of disease-related abscesses in Crohn’s disease. The signicance levels
adopted by all studies was p<0.05.
Results
The results of the individual studies are summarized in Table18.1. We present data
regarding postoperative complications, length of hospital stay (LOS), and need for
subsequent surgery or an intestinal stoma, both for studies comparing PD alone to
surgery alone, and then for studies comparing PD combined with subsequent sur-
gery to surgery alone.
Studies Comparing PD Alone toSurgery Alone
1. Postoperative Complications
Conicting results exist related to the incidence of postoperative complications.
Xie found a signicantly increased incidence in the surgery alone group (9/13,
69%) compared to that of the PD alone group (2/10, 20%), p = 0.036) [3].
However, Liu found no difference in the incidence of complications between the
groups [4].
Three studies reported the incidence of abscess recurrence following PD or
surgery. Two studies found no difference in abscess recurrence [4, 5], but one
study reported a signicantly lower recurrence rate in the surgery alone group
[6]. Garcia grouped “antimicrobial therapy alone” with the “PD alone” in their
comparison versus the “surgery alone” group. Four of 7 (57%) of the PD group
had a recurrent abscess versus 12% (4/34) in the surgery alone group [6].
However, they found no difference in the time to abscess recurrence between
medical management, PD, and surgical intervention groups. Interestingly,
Nguyen reported no difference in the incidence of abscess recurrence at 5years
(PD alone 20.3% versus surgery alone 31.2%, p=0.25.) [5]
S. J. O’Brien and S. Galandiuk
169
Table 18.1 Data summary from individual studies
Author
Study
type Comparison Variable studied Cost-effectiveness
Newcastle-
Ottawa grade
Nguyen etal.
(2012) [5]
a,b
O N=95
PD (55) vs
surgery alone
(40)
LOS:
PD (5 d.) vs Surgery Alone (15.5 d.), p<0.001
Abscess recurrence:
PD (17/55–31%) vs Surgery Alone (8/40–20%)
Abscess recurrence at 5years:
PD 20.3% vs Surgery Alone 31.2% p=0.25
Not analyzed 9
Lobatan etal.
(2013) [7]
a,b
O N=44
PD
(22)+rescue
surgery
(16/22) vs.
surgery alone
(22)
Success of initial treatment:
PD (6/22, 27.2%) vs Surgery Alone (21/22, 95.5%); p<0.001
Length of stay:
PD+Rescue Surgery (56.12±35.89 d.) vs Surgery (27.52±15.11d.);
p=0.017
Postoperative stay:
PD+Rescue Surgery (44.0±83.7d.) vs Surgery Alone (14.3±30 d.);
p=0.179
Postoperative Complications:
PD+Rescue Surgery (7/16–43.8%) vs Surgery Alone (12/22–54.5%);
p=0.75
Need for subsequent surgery:
PD+Rescue Surgery (5/16, 31%) vs Surgery Alone (1/22, 4.5%);
p=0.065
Not analyzed 7
Xie etal.
(2012) [3]
b
O N=23
PD (10) vs.
Initial
Surgery (13)
Post-procedural complications:
Initial PD 2/10 (20%) vs Initial surgery 9/13 (69%), P=0.036
Abscess recurrence:
Initial PD 2/10 (20%) vs Initial surgery 1/13 (8%), Not signicant
Subsequent surgery:
Initial PD 6/10 (60%) vs Initial surgery 4/13 (31%), Not signicant
Stoma creation:
Initial PD 1/10 (10%) vs Initial surgery 9/13(69%), P=0.01
Not analyzed 8
(continued)
18 Role ofPercutaneous Drainage forDisease-Related Abscesses