SYSTEMATIC REVIEWS
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 21, 2015; 21(15): 4735-4743
Published online Apr 21, 2015. doi: 10.3748/wjg.v21.i15.4735
Clinical literature review of 1858 Crohn's disease cases requiring surgery in China
Qing-Hai Peng, Yu-Fang Wang, Man-Qing He, Cui Zhang, Qin Tang
Qing-Hai Peng, Yu-Fang Wang, Man-Qing He, Cui Zhang, Qin Tang, Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Peng QH and Wang YF designed the study; Peng QH, He MQ, Zhang C and Tang Q performed the literature review and summarized and analyzed the data; Peng QH wrote the manuscript; and Wang YF evaluated and edited the manuscript.
Supported by Key Technologies Research and Development Program of China, No. 2012BAI06B03; and National Natural Science Foundation of China, No. 81270447.
Conflict-of-interest: Authors declare no conflict of interest.
Data sharing: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yu-Fang Wang, MD, Associate Professor, Department of Gastroenterology, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Chengdu 610041, Sichuan Province, China. wangyufang04@126.com
Telephone: +86-28-85423387 Fax: +86-28-85582944
Received: September 1, 2014
Peer-review started: September 2, 2014
First decision: October 14, 2014
Revised: November 26, 2014
Accepted: January 16, 2015
Article in press: January 16, 2015
Published online: April 21, 2015
Abstract

AIM: To summarize the clinical characteristics of Crohn’s disease (CD) patients who underwent surgery in China.

METHODS: We searched four main Chinese electronic databases: CBM, VIP, CNKI, and Wanfang (from January 1990 to October 2013). Then, we selected and carefully read 97 studies and extracted the surgical data for CD. We found that 1858 patients with CD underwent surgery between 1961 and 2012. The patients were stratified into two groups according to the year of surgery: 1961-2000 and 2000-2012. The clinical characteristics of these CD cases were compared between the two groups.

RESULTS: The mean age at the time of surgery was 38.13 years. The most common locations of disease were the small intestine (40.84%), the colon (33.60%) and the ileocolon (23.09%). The primary indications for surgery were intestinal obstruction or stricture (23.84%), failure of drug therapy (14.80%), acute abdominal disease (13.46%), abdominal mass (10.93%), intestinal fistulae (9.90%), intestinal perforation (8.45%), perianal disease (6.73%), gastrointestinal bleeding (4.79%), and abdominal abscess (4.04%). The rate of diagnosis of CD before surgery was low (34.78%), and the misdiagnosis rate was 20.49%. The predominant surgical procedure for CD was bowel resection (69.54%). The rate of surgical complications was 20.34%, and the primary complications of surgery were infection (39.44%) and intestinal fistulae (26.09%). The relapse rate after surgery was 27.71%. For the periods of 1961-2000 and 2000-2013, the rates of both misdiagnosis before surgery and surgery related-death decreased (34.90% vs 12.10%, P < 0.001, and 23.53% vs 5.26%, P < 0.001, respectively).

CONCLUSION: The rates of surgical complications and misdiagnosis were higher, whereas the rate of CD-associated tumor and the relapse rate were lower in China than in West countries.

Keywords: Crohn’s disease, Surgery, Surgical indications, Surgical complications, Surgical recurrence

Core tip: There has been no study of the clinical characteristics of a large population of Chinese Crohn’s disease (CD) patients requiring surgery. Based on a literature review, we summarize the clinical characteristics of 1858 patients with CD who underwent surgery in China. The clinical characteristics were generally similar to those reported in the West. However, the rates of surgical complications and misdiagnosis in China were higher than those in Western countries, whereas the rate of CD complicated by tumors and the relapse rate were lower. Further analysis revealed that the surgical outcomes improved during the period examined.