Association between prior appendectomy and the risk and course of Crohn's disease: A systematic review and meta-analysis - 02/03/23

Doi : 10.1016/j.clinre.2023.102090

Lei Zhang ^a,^b,^{^{&
These authors contributed equally to this work.}}, Chenhao Hu ^a,^b,^{^{&
These authors contributed equally to this work.}}, Zhe Zhang ^a,^b, Ruihan Liu ^b, Gaixia Liu ^a,^b, Dong Xue ^a,^b, Zhe Wang ^a,^b, Chenxi Wu ^a,^b, Xuefu Wu ^a,^b, Junjun She ^a,^b,^⁎ , Feiyu Shi ^a,^b,^⁎
^a Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
^b Center for Gut Microbiome Research, Med-X Institute, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China

^⁎Corresponding authors.

Highlights

•	In this work, we demonstrated a significant risk of Crohn's disease following an appendectomy which persisted even after 5 years postoperative. The elevated risk may mainly occur in terminal ileum. This phenomenon should receive more attention from clinicians.

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Abstract

Background and aims

The appendix has an important immune function in both health and disease, and appendectomy may influence microbial ecology and immune function. This meta-analysis aims to assess the association between appendectomy and the risk and course of Crohn's disease (CD).

Methods

PubMed, EMBASE, and the Cochrane Library were used to identify all studies published until June 2022. Data from studies evaluating the association between appendectomy and CD were reviewed.

Results

A total of 28 studies were included in the final analysis, comprising 22 case-control and 6 cohort studies. A positive relationship between prior appendectomy and the risk of developing CD was observed in both case-control studies (odds ratio [OR]: 1.59, 95% confidence interval [CI]: 1.22–2.08) and cohort studies (relative risk [RR]: 2.28, 95% CI: 1.66–3.14). The elevated risk of CD persisted 5 years post-appendectomy (RR = 1.24, 95% CI: 1.12–1.36). The risk of developing CD was similarly elevated regardless of the presence (RR = 1.64, 95% CI: 1.17–2.31) or absence (RR = 2.77, 95% CI: 1.84–4.16) of appendicitis in patients. Moreover, significant differences were found in the proportion of terminal ileum lesions (OR = 1.63; 95% CI: 1.38–1.93) and colon lesions (OR = 0.70; 95% CI: 0.5–0.84) between CD patients with appendectomy and those without appendectomy.

Conclusions

The risk of developing CD following an appendectomy is significant and persists 5 years postoperatively. Moreover, the elevated risk of CD may mainly occur in the terminal ileum.

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Keywords : Crohn's disease, Appendectomy, Meta-analysis

Abbreviations : CD, PRISMA, SIR, OR, RR, HR, CIs, NOS, GALT