Long-term oncological outcome of segmental versus extended colectomy for colorectal cancer in Crohn's disease: results from an international multicentre study

Background and aims: Crohn's Disease increases colorectal cancer risk, with high prevalence of synchronous and metachronous cancers. Current guidelines for colorectal cancer in Crohn's Disease recommend pan-proctocolectomy. Aim of this study was to evaluate oncologic outcomes of a less invasive surgical approach. Methods: Retrospective database analysis of Crohn's disease patients with colorectal cancer undergoing surgery at selected European and U.S. tertiary centres. Outcomes of segmental colectomy were compared with those of extended colectomy: total colectomy and pan-proctocolectomy. Primary outcome was progression-free survival. Secondary outcomes included overall survival, synchronous and metachronous colorectal cancer and major postoperative complications. Results: Ninety-nine patients were included: 66 patients underwent segmental colectomy and 33 extended colectomy. Segmental colectomy patients were older (p= 0.0429), had less extensive colitis (p = 0.0002) and no pre-operatively identified synchronous lesions (p = 0.0109).Median follow up was 43 (31-62) months. There was no difference in unadjusted progression-free survival (p = 0.2570) nor in overall survival (p = 0.4191) between segmental and extended colectomy. Multivariate analysis adjusting for age, sex, ASA score and AJCC staging, confirmed no difference for progression-free survival (HR 1.00 p = 0.9993) or overall survival (HR 0.77 p = 0.6654). Synchronous and metachronous cancers incidence was 9% and 1.5% respectively. Perioperative mortality was nil and major complications were comparable (7.58% vs 6.06% p = 0.9998). Conclusions: Segmental colectomy seems to offer similar long-term outcomes to more extensive surgery. Incidence of synchronous and metachronous cancers appears much lower than previously described. Further prospective studies are warranted to confirm these results