Recurrence of Crohn's disease after resection. Are there any risk factors?

We report two studies on possible risk factors for postoperative recurrence of Crohn's disease and an extensive literature review. In our retrospective study, 90 patients who had undergone curative resection and anastomosis 1 to 22 years (average 9.3 years) previously were examined. The recurrence rate, calculated by actuarial methods, was 62.2% after 10 years and 86.4% after 15 years. The site of recurrence was clearly related to the initial location of disease (p less than 0.001). However, of the various clinical, pathological, and surgical factors studied, only the preoperative history correlated directly with recurrence (p less than 0.05). The prospective study evaluated the influence on recurrence of microscopic lesions at grossly free margins of ileocecal resection. Twenty-two consecutive patients, operated on for Crohn's disease of the terminal ileum from 6 to 34 months previously (average 24 months), were studied. From the histological grading previously established, recurrence was independent of involvement at both proximal and distal section lines. Therefore, we recommend conservative resection to obtain only grossly uninvolved margins.