Takahide Shinagawa1, Keisuke Hata2, Hiroki Ikeuchi3, Kouhei Fukushima4, Kitaro Futami5, Akira Sugita6, Motoi Uchino3, Kazuhiro Watanabe7, Daijiro Higashi5, Hideaki Kimura8, Toshimitsu Araki9, Tsunekazu Mizushima10, Michio Itabashi11, Takeshi Ueda12, Kazutaka Koganei6, Koji Oba13, Soichiro Ishihara1, Yasuo Suzuki14. 1. Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan. 2. Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan. Electronic address: khata-tky@umin.ac.jp. 3. Department of Inflammatory Bowel Disease, Division of Surgery, Hyogo College of Medicine, Nishinomiya, Japan. 4. Division of Surgical and Molecular Pathophysiology, Graduate School of Medicine, Tohoku University, Sendai, Japan; Laboratory of Gastrointestinal Reconstruction, Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan. 5. Department of Surgery, Fukuoka University Chikushi Hospital, Chikushino, Japan. 6. Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, Yokohama, Japan. 7. Department of Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan. 8. Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan. 9. Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan. 10. Department of Gastroenterological Surgery, Therapeutics for Inflammatory Bowel Diseases, Osaka University Graduate School of Medicine, Osaka, Japan. 11. Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan. 12. Department of Surgery, Nara Medical University, Kashihara, Japan. 13. Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Nishinomiya, Japan. 14. Department of Internal Medicine, Sakura Medical Centre, Toho University, Tokyo, Japan.
Abstract
BACKGROUND & AIMS: Patients with Crohn's disease (CD) can require multiple intestinal surgeries. We examined time trends and risk factors for reoperation in patients with CD who underwent intestinal surgery, focusing on the effects of postoperative medical treatments. METHODS: We performed a retrospective analysis of 1871 patients with CD who underwent initial intestinal resection at 10 tertiary care institutions in Japan, with an initial surgical date after May 1982. We collected data on the background characteristics of all patients, including Montreal Classification, smoking status, and medical therapy after surgery (tumor necrosis factor antagonists [anti-TNF] agents or immunomodulators). The primary outcome was requirement for first reoperation. Rate of reoperation was estimated using the Kaplan-Meier method, and risk factors for reoperation were identified using the Cox regression model. RESULTS: The overall cumulative 5- and 10-year reoperation rates were 23.4% and 48.0%, respectively. Multivariable analysis showed that patients who underwent the initial surgery after May 2002 had a significantly lower rate of reoperation than patients who underwent surgery before April 2002 (hazard ratio [HR], 0.72; 95% CI, 0.61-0.86). Preoperative smoking (HR, 1.40; 95% CI, 1.18-1.68), perianal disease (HR, 1.50; 95% CI, 1.27-1.77), and ileocolic type of CD (HR, 1.42; 95% CI, 1.20-1.69) were significant risk factors for reoperation. Postoperative use of immunomodulators (HR, 0.60; 95% CI, 0.44-0.81) and anti-TNF therapy (HR, 0.71; 95% CI, 0.57-0.88) significantly reduced the risk. Anti-TNF was effective in the bionaive subgroup. CONCLUSIONS: The rate of reoperation in patients with CD significantly decreased after May 2002. Postoperative use of anti-TNF agents might reduce the reoperation rate for bionaive patients with CD.
BACKGROUND & AIMS:Patients with Crohn's disease (CD) can require multiple intestinal surgeries. We examined time trends and risk factors for reoperation in patients with CD who underwent intestinal surgery, focusing on the effects of postoperative medical treatments. METHODS: We performed a retrospective analysis of 1871 patients with CD who underwent initial intestinal resection at 10 tertiary care institutions in Japan, with an initial surgical date after May 1982. We collected data on the background characteristics of all patients, including Montreal Classification, smoking status, and medical therapy after surgery (tumor necrosis factor antagonists [anti-TNF] agents or immunomodulators). The primary outcome was requirement for first reoperation. Rate of reoperation was estimated using the Kaplan-Meier method, and risk factors for reoperation were identified using the Cox regression model. RESULTS: The overall cumulative 5- and 10-year reoperation rates were 23.4% and 48.0%, respectively. Multivariable analysis showed that patients who underwent the initial surgery after May 2002 had a significantly lower rate of reoperation than patients who underwent surgery before April 2002 (hazard ratio [HR], 0.72; 95% CI, 0.61-0.86). Preoperative smoking (HR, 1.40; 95% CI, 1.18-1.68), perianal disease (HR, 1.50; 95% CI, 1.27-1.77), and ileocolic type of CD (HR, 1.42; 95% CI, 1.20-1.69) were significant risk factors for reoperation. Postoperative use of immunomodulators (HR, 0.60; 95% CI, 0.44-0.81) and anti-TNF therapy (HR, 0.71; 95% CI, 0.57-0.88) significantly reduced the risk. Anti-TNF was effective in the bionaive subgroup. CONCLUSIONS: The rate of reoperation in patients with CD significantly decreased after May 2002. Postoperative use of anti-TNF agents might reduce the reoperation rate for bionaive patients with CD.
Authors: Lester Tsai; Christopher Ma; Parambir S Dulai; Larry J Prokop; Samuel Eisenstein; Sonia L Ramamoorthy; Brian G Feagan; Vipul Jairath; William J Sandborn; Siddharth Singh Journal: Clin Gastroenterol Hepatol Date: 2020-10-27 Impact factor: 13.576