Long-term treatment outcomes of complicated acute diverticulitis in immunocompromised patients.

IF 2.5 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY International Journal of Colorectal Disease Pub Date : 2024-11-04 DOI:10.1007/s00384-024-04753-1
Jorge Sancho-Muriel, Hanna Cholewa, Mónica Millán, David Quevedo, Eduardo Alvarez, Marta Nieto-Sanchez, Raquel Blasco, Francisco Giner, Maria Jose Gomez, Vicent Primo-Romaguera, Matteo Frasson, Blas Flor-Lorente
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Abstract

Purpose: The main aim of this study was to determine the short- and long-term outcomes of the non-operative management of acute left-sided complicated diverticulitis (ALCD) in severely immunocompromised patients (IMS group) and compare them with immunocompetent patients (IC group). The secondary aim was to assess the necessity of an elective surgery following a successful prior non-operative management in the IMS group after a non-operative management of the first episode of ALCD.

Methods: Patients presented with their first episode of ALCD between 2012 and 2018 were retrospectively reviewed. Only severely immunosuppressed patients were considered for the analysis, including the following: long-term oral or intravenous steroid intake, current malignancy undergoing chemotherapy, chronic kidney disease on hemodialysis, or solid organ transplant with immunosuppressive medication. For each group, demographic data, severity of the episode, management decisions (conservative or operative), and short- and long-term outcomes were recorded and compared. A sub-analysis of patients with ALCD associating and abscess (modified Hinchey classification Ib/II) was performed.

Results: A total of 290 patients were included in the study: 50 among the IMS and 240 among the IC group. The rate of emergent surgery was higher in the IMS group (50.0% vs. 22.5%, p < 0.001) and was associated with increased morbidity (72.4% vs. 50.0%, p = 0.041) and mortality (24.1% vs. 4.3%, p = 0.003). The duration of the hospital stay was significantly longer in the IMS group (15 vs. 8 days, p < 0.001). The final stoma rate was significantly higher in the IMS group (82.1% vs. 22.9, p < 0.001), with a median follow-up of 51.4 months. A total of 141 patients presented ALCD with an abscess; 25 in the IMS and 116 in the IC group. There was a higher rate of surgical intervention among the IMS group as the initial treatment approach (24.0% vs. 5.2%, p = 0.002), even though the conservative treatment had a similar rate of success (81.3% vs. 92.0%, p = 0.178). The recurrence rate following a non-operative approach was similar (IMS: 31.2% vs. 35.4% in the IC group, p = 0.169). Furthermore, 81.2% of non-operatively managed IMS patients (13 out of 16) did not require a surgical intervention at the end of the follow-up, with similar findings in the IC group (78/96, 81.2%, p = 0.148).

Conclusion: Medical treatment of immunosuppressed patients during their first ALCD episode associated with an abscess is feasible, with a high success rate and results comparable with the IC group. Moreover, taking into account the readmission rates, the need for emergent surgery of the recurrence, and the perioperative mortality and morbidity in the IMS group, conservative management with no differed scheduled surgery seems to be a safe option in this subgroup of patients.

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免疫力低下患者并发急性憩室炎的长期治疗效果。
目的:本研究的主要目的是确定严重免疫功能低下患者(IMS 组)急性左侧复杂性憩室炎(ALCD)非手术治疗的短期和长期疗效,并将其与免疫功能正常患者(IC 组)进行比较。次要目的是评估 IMS 组患者在非手术治疗首次急性左侧复杂性憩室炎成功后是否有必要进行择期手术:对2012年至2018年间首次发病的ALCD患者进行回顾性研究。分析仅考虑严重免疫抑制患者,包括以下情况:长期口服或静脉注射类固醇、正在接受化疗的恶性肿瘤、接受血液透析的慢性肾病或接受免疫抑制药物的实体器官移植。对每组患者的人口统计学数据、病情严重程度、治疗决定(保守治疗或手术治疗)以及短期和长期疗效进行了记录和比较。此外,还对伴有脓肿的 ALCD 患者(修改后的 Hinchey 分级 Ib/II)进行了子分析:研究共纳入了 290 名患者:结果:共有 290 名患者参与了研究:50 名患者属于 IMS 组,240 名患者属于 IC 组。IMS 组的急诊手术率更高(50.0% 对 22.5%,P 结论:IMS 组的急诊手术率更高:对首次出现伴有脓肿的 ALCD 的免疫抑制患者进行药物治疗是可行的,成功率高,效果与 IC 组相当。此外,考虑到 IMS 组的再入院率、复发时的紧急手术需求以及围手术期的死亡率和发病率,对这一亚组患者而言,不进行不同计划手术的保守治疗似乎是一种安全的选择。
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来源期刊
CiteScore
4.90
自引率
3.60%
发文量
206
审稿时长
3-8 weeks
期刊介绍: The International Journal of Colorectal Disease, Clinical and Molecular Gastroenterology and Surgery aims to publish novel and state-of-the-art papers which deal with the physiology and pathophysiology of diseases involving the entire gastrointestinal tract. In addition to original research articles, the following categories will be included: reviews (usually commissioned but may also be submitted), case reports, letters to the editor, and protocols on clinical studies. The journal offers its readers an interdisciplinary forum for clinical science and molecular research related to gastrointestinal disease.
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