E Lautenbach1, J A Berlin, G R Lichtenstein. 1. Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Abstract
BACKGROUND & AIMS: Despite many advances in our understanding of Crohn's disease, the course of the disease in any given patient remains unpredictable. There is little agreement as to which factors increase a patient's risk of early postoperative recurrence. We have attempted to identify predictors of early recurrence after surgical resection, specifically whether the indication for initial surgery (perforating or nonperforating) or the duration of preoperative disease may be associated with early recurrence. METHODS: We studied 88 patients who had undergone at least two resections for Crohn's disease. Multivariable survival analysis was performed to elucidate predictors of early postoperative recurrence. RESULTS: A perforating indication for initial surgery (P < 0.001) and a longer preoperative disease duration (P = 0.004) were found to be the only independent predictors of earlier postoperative recurrence after initial surgery. A longer preoperative disease duration also showed a borderline significant association with a shorter interval from second to third surgery (P = 0.075). Finally, the indication for initial surgery was predictive of the indication at a subsequent surgery for recurrence (P = 0.001). CONCLUSIONS: A perforating indication for initial resection and a longer duration of disease before initial surgery predicted an earlier postoperative recurrence. The latter association was borderline. This suggests that prognostic groups based on these factors may help to stratify patients with regard to risk of early recurrence.
BACKGROUND & AIMS: Despite many advances in our understanding of Crohn's disease, the course of the disease in any given patient remains unpredictable. There is little agreement as to which factors increase a patient's risk of early postoperative recurrence. We have attempted to identify predictors of early recurrence after surgical resection, specifically whether the indication for initial surgery (perforating or nonperforating) or the duration of preoperative disease may be associated with early recurrence. METHODS: We studied 88 patients who had undergone at least two resections for Crohn's disease. Multivariable survival analysis was performed to elucidate predictors of early postoperative recurrence. RESULTS: A perforating indication for initial surgery (P < 0.001) and a longer preoperative disease duration (P = 0.004) were found to be the only independent predictors of earlier postoperative recurrence after initial surgery. A longer preoperative disease duration also showed a borderline significant association with a shorter interval from second to third surgery (P = 0.075). Finally, the indication for initial surgery was predictive of the indication at a subsequent surgery for recurrence (P = 0.001). CONCLUSIONS: A perforating indication for initial resection and a longer duration of disease before initial surgery predicted an earlier postoperative recurrence. The latter association was borderline. This suggests that prognostic groups based on these factors may help to stratify patients with regard to risk of early recurrence.
Authors: R Caprilli; M A Gassull; J C Escher; G Moser; P Munkholm; A Forbes; D W Hommes; H Lochs; E Angelucci; A Cocco; B Vucelic; H Hildebrand; S Kolacek; L Riis; M Lukas; R de Franchis; M Hamilton; G Jantschek; P Michetti; C O'Morain; M M Anwar; J L Freitas; I A Mouzas; F Baert; R Mitchell; C J Hawkey Journal: Gut Date: 2006-03 Impact factor: 23.059
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