TY - JOUR
T1 - Short- and medium-term outcomes following primary ileocaecal resection for Crohn's disease in two specialist centres
AU - de Buck van Overstraeten, A.
AU - Eshuis, E. J.
AU - Vermeire, S.
AU - van Assche, G.
AU - Ferrante, M.
AU - D'Haens, G. R.
AU - Ponsioen, C. Y.
AU - Belmans, A.
AU - Buskens, C. J.
AU - Wolthuis, A. M.
AU - Bemelman, W. A.
AU - D'Hoore, A.
PY - 2017
Y1 - 2017
N2 - Background: Despite improvements in medical therapy, the majority of patients with Crohn's disease still require surgery. The aim of this study was to report safety, and clinical and surgical recurrence rates, including predictors of recurrence, after ileocaecal resection for Crohn's disease. Methods: This was a cohort analysis of consecutive patients undergoing a first ileocaecal resection for Crohn's disease between 1998 and 2013 at one of two specialist centres. Anastomotic leak rate and associated risk factors were assessed. Kaplan-Meier estimates were used to describe long-term clinical and surgical recurrence. Univariable and multivariable regression analyses were performed to identify risk factors for both endpoints. Results: In total, 538 patients underwent primary ileocaecal resection (40.0 per cent male; median age at surgery 31 (i.q.r. 24-42) years). Median follow-up was 6 (2-9) years. Fifteen of 507 patients (3.0 per cent) developed an anastomotic leak. An ASA fitness grade of III (odds ratio (OR) 4.34, 95 per cent c.i. 1.12 to 16.77; P = 0.033), preoperative antitumour necrosis factor therapy (OR 3.30, 1.09 to 9.99; P = 0.035) and length of resected bowel specimen (OR 1.06, 1.03 to 1.09; P <0.001) were significant risk factors for anastomotic leak. Rates of clinical recurrence were 17.6, 45.4 and 55.0 per cent after 1, 5 and 10 years respectively. Corresponding rates of requirement for further surgery were 0.6, 6.5 and 19.1 per cent. Smoking (hazard ratio (HR) 10.67, 95 per cent c.i. 1.14 to 2.43; P = 0.008) and a positive microscopic resection margin (HR 2.16, 1.46 to 3.21; P <0.001) were independent risk factors for clinical recurrence. Microscopic resection margin positivity was also a risk factor for further surgery (HR 2.99, 1.36 to 6.54; P = 0.006). Conclusion: Ileocaecal resection achieved durable medium-term remission, but smoking and resection margin positivity were risk factors for recurrence
AB - Background: Despite improvements in medical therapy, the majority of patients with Crohn's disease still require surgery. The aim of this study was to report safety, and clinical and surgical recurrence rates, including predictors of recurrence, after ileocaecal resection for Crohn's disease. Methods: This was a cohort analysis of consecutive patients undergoing a first ileocaecal resection for Crohn's disease between 1998 and 2013 at one of two specialist centres. Anastomotic leak rate and associated risk factors were assessed. Kaplan-Meier estimates were used to describe long-term clinical and surgical recurrence. Univariable and multivariable regression analyses were performed to identify risk factors for both endpoints. Results: In total, 538 patients underwent primary ileocaecal resection (40.0 per cent male; median age at surgery 31 (i.q.r. 24-42) years). Median follow-up was 6 (2-9) years. Fifteen of 507 patients (3.0 per cent) developed an anastomotic leak. An ASA fitness grade of III (odds ratio (OR) 4.34, 95 per cent c.i. 1.12 to 16.77; P = 0.033), preoperative antitumour necrosis factor therapy (OR 3.30, 1.09 to 9.99; P = 0.035) and length of resected bowel specimen (OR 1.06, 1.03 to 1.09; P <0.001) were significant risk factors for anastomotic leak. Rates of clinical recurrence were 17.6, 45.4 and 55.0 per cent after 1, 5 and 10 years respectively. Corresponding rates of requirement for further surgery were 0.6, 6.5 and 19.1 per cent. Smoking (hazard ratio (HR) 10.67, 95 per cent c.i. 1.14 to 2.43; P = 0.008) and a positive microscopic resection margin (HR 2.16, 1.46 to 3.21; P <0.001) were independent risk factors for clinical recurrence. Microscopic resection margin positivity was also a risk factor for further surgery (HR 2.99, 1.36 to 6.54; P = 0.006). Conclusion: Ileocaecal resection achieved durable medium-term remission, but smoking and resection margin positivity were risk factors for recurrence
U2 - https://doi.org/10.1002/bjs.10595
DO - https://doi.org/10.1002/bjs.10595
M3 - Article
C2 - 28745410
SN - 0007-1323
VL - 104
SP - 1713
EP - 1722
JO - British Journal of Surgery
JF - British Journal of Surgery
IS - 12
ER -