BACKGROUND/AIMS: Surgery for Crohn's disease is frequently followed by symptomatic recurrence, which in up to 40% requires reoperation within 6 years. Whilst there is evidence that postoperative medical prophylaxis can be efficient, the results of clinical trials are inconsistent regarding the achieved benefit for the patient. Several parameters have been claimed to indicate an increased intrinsic risk of early surgical recurrence. METHODOLOGY: Patient charts of 287 patients who had undergone abdominal surgery for Crohn's disease were reviewed. Mean follow-up was 4.4 years. Recurrence-free intervals were calculated by the Kaplan-Meier method. A uni- and multivariate analysis was conducted to assess the impact of possible indicators of the need of repeated surgery. RESULTS: Patients with fistulizing type of symptoms, extraintestinal manifestations, corticosteroid treatment or male gender experienced significantly earlier reoperation. Recurrent disease, histologic evidence of inflamed resection margins, patient's age at the time of primary diagnosis and operation and the presence of epitheloid granulomas did not show significant influence on recurrence-free intervals. CONCLUSIONS: We conclude that the natural course of disease after intestinal resection in patients with one or more of these risk factors tends towards earlier recurrence requiring surgical intervention. The risk factors identified in this trial may be useful for patient stratification for randomized trials on the efficacy of medical prophylaxis.
BACKGROUND/AIMS: Surgery for Crohn's disease is frequently followed by symptomatic recurrence, which in up to 40% requires reoperation within 6 years. Whilst there is evidence that postoperative medical prophylaxis can be efficient, the results of clinical trials are inconsistent regarding the achieved benefit for the patient. Several parameters have been claimed to indicate an increased intrinsic risk of early surgical recurrence. METHODOLOGY:Patient charts of 287 patients who had undergone abdominal surgery for Crohn's disease were reviewed. Mean follow-up was 4.4 years. Recurrence-free intervals were calculated by the Kaplan-Meier method. A uni- and multivariate analysis was conducted to assess the impact of possible indicators of the need of repeated surgery. RESULTS:Patients with fistulizing type of symptoms, extraintestinal manifestations, corticosteroid treatment or male gender experienced significantly earlier reoperation. Recurrent disease, histologic evidence of inflamed resection margins, patient's age at the time of primary diagnosis and operation and the presence of epitheloid granulomas did not show significant influence on recurrence-free intervals. CONCLUSIONS: We conclude that the natural course of disease after intestinal resection in patients with one or more of these risk factors tends towards earlier recurrence requiring surgical intervention. The risk factors identified in this trial may be useful for patient stratification for randomized trials on the efficacy of medical prophylaxis.
Authors: Thilo Welsch; Ulf Hinz; Thorsten Löffler; Gregor Muth; Christian Herfarth; Jan Schmidt; Peter Kienle Journal: Int J Colorectal Dis Date: 2007-03-28 Impact factor: 2.571
Authors: F L Wolters; M G Russel; J Sijbrandij; T Ambergen; S Odes; L Riis; E Langholz; P Politi; A Qasim; I Koutroubakis; E Tsianos; S Vermeire; J Freitas; G van Zeijl; O Hoie; T Bernklev; M Beltrami; D Rodriguez; R W Stockbrügger; B Moum Journal: Gut Date: 2005-12-16 Impact factor: 23.059
Authors: A Tursi; W Elisei; M Picchio; C Zampaletta; G Pelecca; R Faggiani; G Brandimarte Journal: Tech Coloproctol Date: 2014-06-12 Impact factor: 3.781
Authors: Yusuf Erzin; Gürhan Şişman; İbrahim Hatemi; Bilgi Baca; İsmail Hamzaoglu; Ahmet Dirican; Uğur Korman; Aykut F Çelik Journal: Turk J Gastroenterol Date: 2020-04 Impact factor: 1.852