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Surgical Prognosis Factors for Recurrence After Resection of Ileocecal Crohn's Disease
Rocio Anula*, Julio Mayol, Jana Dziaková, Diego Sierra, Bibiana Lasses, Juan L. CabañAs, Jesus Alvarez
Surgery, Hospital Clínico San Carlos, Madrid, Spain
BACKGROUND
Recurrence of Crohn's disease (CD) after ileocolic resection is a major challenge for gastroenterologists and surgeons. It would be important to have good markers of the postoperative course to tailor medical and surgical management. The aim of this retrospective study was to identify surgical risk factors for postoperative recurrence after primary ileocolic resection, and to evaluate possible prognostic factors that could help to optimize postoperative management.
PATIENTS AND METHODS
The medical records of patients who consecutively underwent ileocolic resection for CD between 1966 and 2011 and had been followed at our institution, were retrospectively reviewed. The diagnosis of CD was based on clinical, radiological and histological criteria. Recurrence was defined as the presence of symptoms attributable to CD and the presence of compatible lesions adjacent to the anastomosis in the resected bowel. The following variables related to surgical treatment were evaluated: age at time of surgery, surgical approach, indication for surgery, surgical technique, anastomotic configuration and postoperative complications. Univariate analysis was used to determine those factors related to recurrence and a multivariate logistic regression analysis was performed to identify independent prognosis factors for postoperative recurrence. Statistical significance was defined as p < 0.05.
RESULTS
A total of 214 patients were included in the study, 111were men and 103 women. The median age at the time of surgery was 34.1 years (IQR: 27.1- 47.0). After a mean follow-up of 2.99 years (IQR: 0.9- 6.8), the overalll cumulative recurrence rate was 76.8%. Overall, the disease-free rate at 12 and 24 months was 82.9% y 71.7% respectively. Patients who recurred were younger at time of resection (p50: 32,5 years; IQR:26,9- 46,0, p50:39,0; IQR:29,9- 53,7, respectively; p=0.027). Multivariate logistic regression analysis showed that anastomotic configuration (end-to-end or side-to-end) was a significant risk factor for recurrence (OR=2.56, 95% IC=0.93-7.03; p=0.067). Regarding the disease-free interval after surgery, the laparoscopic approach was associated with longer time to recurrence (p=0.020) in the univariate analysis, while the multivariate analysis showed that anastomotic configuration was a significant prognosis factor (HR=2.11, 95% IC=1.01- 4.41; p=0.047).
CONCLUSIONS
Surgical factors, such as the approach or the anastomotic configuration, are associated with an increased risk of recurrence, while others (indication for surgery and surgical technique) do not seem to have any relevance. These findings should be considered when an elective ilecolic resection for Crohn's disease is planned.
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