Colonic resection ups postsurgery recurrence in Crohn’s disease
Crohn’s disease patients who undergo colonic resection are more prone to postsurgery recurrence of the disease, reports a recent study.
The study included 193 Crohn’s disease patients (mean age 52±12 years; 107 males), of whom 105 had ileal and 36 had colonic disease. Most of the participants did not have perianal (n=145) or extraintestinal (n=180) disease. Mesalamine was the most common concomitant therapy at enrolment.
Over a median follow-up duration of 56 months, more than half (53 percent; n=102) of the participants experienced postsurgery recurrence of Crohn’s disease. In most of these, medical therapy was sufficient to treat the recurring disease (71 percent); a second surgery was required in 29 percent of the cases.
Multivariate logistic regression analysis identified active smoking after surgery (hazard ratio [HR], 2.3; 95 percent CI, 1.3–4.2; p=0.007) and being ≤40 years of age at initial Crohn’s disease diagnosis (HR, 2.1; 1.1–4.3; p=0.03) as significant and independent risk factors for recurrence. Cox regression modelling further specified that compared to nonsmokers, the median time to recurrence was shorter in smokers (45 vs 82 months).
Notably, univariate analysis showed that colonic or ileocolonic resection significantly increased the risk of recurrence relative to ileal resection (HR, 3.0; 1.4–6.2; p=0.004). The same was true for the lack of immunosuppressive or biologic therapy after surgery (HR, 2.3; 1.0–5.3; p=0.05).
Exclusion of patients who received postsurgery prophylactic treatment from the surgery did not attenuate the interaction between colonic/ileocolonic resection on the risk of recurrence (HR, 3.2; 1.1–8.9; p=0.03). Survival analysis further showed that recurrence-free time was significantly reduced in patients who underwent isolated colonic resection (p=0.006).