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Clinical and Surgical Recurrences in Crohn Disease (CD): A-15 Years Follow-Up Cohort Study From Northern Italy Tertiary Center
Amedeo Indriolo*2, Gabriela Elisa Nita1, Luca Campanati1, Elia Poiasina1, Paolo Ravelli2, Luca Ansaloni1
1General Surgery Unit, Papa Giovanni XXIII Hospital, Bergamo, BG, Italy; 2Gastroenterology and Digestive Endoscopy Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
Between 2000-2015, an interdisciplinary team of gastroenterologists and surgeons were joined together for the clinical management of patients (pts) with Inflammatory Bowel Disease from a tertiary Center in Northern Italy.
The aim of the study was evaluate the incidence of intestinal resection and perianal procedure during 15 years follow-up and its clinical and intestinal resection recurrence among CD pts.
During this period we attended 204 patients with CD. From the database IBD, the parameters were considered: year of on-set, localisation gastro-enteric (GE) tract, year and the type of surgery, clinical and surgical recurrence at 1, 5, 10, and 15 years of follow-up. Results were processed in an univariate analysis. The presence of clinical recurrence means CDAI >150.
The male were 50,5%, the median on-set age was 34 years, (6-86), and a median follow-up period of 8 years(1-56).
19,6% were lost at follow-up, 3,43% died, 2,4% for colo-rectal cancer. 94% reached 1 year of follow-up, 80% 5 years, 53% 10 years, 34% 15 years, respectively.
The primarily involved GE tract was ileo-colonic, 49% as last ileal loop and ciecal colonic tract (L1), in 24,5% there was only an ileal involvement (L1), a 21% had a colo-rectal involvement (L2) and in 1% the gastro-duodenal tract was afflicted (L4). 3% had a perineal involvement.
53,4% underwent surgery. 45% underwent abdominal intervention for intestinal resection, 7% underwent a perineal procedure. 1% were treated with perineal and derivative combined procedure. 30% underwent emergency surgery for CD’s complication, of whom 24% underwent abdominal procedures and in 1% the combined procedure was necessary. The incidence of intestinal resection and perineal procedure were 24%/5% at the on-set, 29%/12% at 1 year, 47%/9% at 5 years, 51%/8% at 10 years, 63% and 8% at 15 years, respectively. (Figure 1).
The incidence of clinical and intestinal resection recurrence were 61%/0% at 1 year, 48%/5% at 5 years, 27%/4% at 10 years, 34%/7% at 15 years, respectively. (Figure 2)
In many cases the surgical treatment is still performed at the clinical on-set, due to complications. The clinical recurrence is increased at 5 years of follow-up, and diminished after. The incidence of perineal procedure is constant in the follow-up, while intestinal resection increases during follow-up.
 
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