Top

Journal of Gastrointestinal Surgery

Published in:

01-08-2012 | Original Article

Frequency and Risk Factors of Postoperative Recurrence of Crohn’s Disease After Intestinal Resection in the Chinese Population

Authors: Yi Li, Weiming Zhu, Lugen Zuo, Wei Zhang, Jianfeng Gong, Lili Gu, Lei Cao, Ning Li, Jieshou Li

Published in: Journal of Gastrointestinal Surgery | Issue 8/2012

Abstract

Background

Data on risk factors of postoperative recurrence in patients with Crohn’s disease (CD) have shown conflicting results. The aim of this retrospective study is to identify predictors of early symptomatic recurrence of CD after surgical intestinal resection in the Chinese population.

Materials and Methods

Patients diagnosed as CD who underwent intestinal resection in Jinling Hospital between May 2004 and December 2010 were included in our study. Clinical data of these patients were reviewed. Multivariable survival analysis was performed to elucidate risk factors of early postoperative symptomatic recurrence.

Results

There were a total of 141 CD patients who had at least one previous curative resection for CD under regular follow-up in our unit. Our data indicated disease behavior (95 % CI 1.01–1.70, P = 0.044), smoking habits (95 % CI 1.32–2.84, P = 0.001), indication of perforation (95 % CI 1.09–4.02, P = 0.026), and location of anastomosis (95 % CI 1.09–3.39, P = 0.023) which are, as a result, strong independent predictors of symptomatic recurrence, while the anastomosis type as side-to-side anastomosis (SSA) was significantly associated with a decreased risk of symptomatic recurrence when compared with other anastomosis type (95 % CI 0.26–0.94, P = 0.038). Medical prophylaxes also played a role in the prevention of postoperative symptomatic recurrence.

Conclusions

A smoking habits and perforation indication for surgery at the time of resection are associated with an increased risk of symptomatic recurrence. Anastomosis type with SSA is associated with a reduced risk of symptomatic recurrence. This population-based study supports the concept that environmental factors, disease character, and surgical technique influence the risk of postoperative symptomatic recurrence of CD.

Leong RW, Lau JY, Sung JJ. The epidemiology and phenotype of Crohn’s disease in the Chinese population. Inflamm Bowel Dis 2004;10(5):646–51.PubMedCrossRef

Solberg IC, Vatn MH, Hoie O, Stray N, Sauar J, Jahnsen J, et al. Clinical course in Crohn’s disease: results of a Norwegian population-based ten-year follow-up study. Clin Gastroenterol Hepatol 2007;5(12):1430–8.PubMedCrossRef

Sachar DB. The problem of postoperative recurrence of Crohn’s disease. Med Clin North Am 1990;74(1):183–8.PubMed

Ng SC, Kamm MA. Management of postoperative Crohn’s disease. Am J Gastroenterol 2008;103(4):1029–35.PubMedCrossRef

Lindberg E, Jarnerot G, Huitfeldt B. Smoking in Crohn’s disease: effect on localisation and clinical course. Gut 1992;33(6):779–82.PubMedCrossRef

Williams JG, Wong WD, Rothenberger DA, Goldberg SM. Recurrence of Crohn’s disease after resection. Br J Surg 1991;78(1):10–9.PubMedCrossRef

Alvarez-Lobos M, Arostegui JI, Sans M, Tassies D, Plaza S, Delgado S, et al. Crohn’s disease patients carrying Nod2/CARD15 gene variants have an increased and early need for first surgery due to stricturing disease and higher rate of surgical recurrence. Ann Surg 2005;242(5):693–700.PubMedCrossRef

Caprilli R, Gassull MA, Escher JC, Moser G, Munkholm P, Forbes A, et al. European evidence based consensus on the diagnosis and management of Crohn’s disease: special situations. Gut 2006;55 Suppl 1:i36–58.PubMedCrossRef

Bernell O, Lapidus A, Hellers G. Risk factors for surgery and recurrence in 907 patients with primary ileocaecal Crohn’s disease. Br J Surg 2000;87(12):1697–701.PubMedCrossRef

10.

Travis SP, Stange EF, Lemann M, Oresland T, Chowers Y, Forbes A, et al. European evidence based consensus on the diagnosis and management of Crohn’s disease: current management. Gut 2006;55 Suppl 1:i16–35.PubMedCrossRef

11.

Yamamoto T, Keighley MR. Smoking and disease recurrence after operation for Crohn’s disease. Br J Surg 2000;87(4):398–404.PubMedCrossRef

12.

Fichera A, McCormack R, Rubin MA, Hurst RD, Michelassi F. Long-term outcome of surgically treated Crohn’s colitis: a prospective study. Dis Colon Rectum 2005;48(5):963–9.PubMedCrossRef

13.

Scarpa M, Angriman I, Barollo M, Polese L, Ruffolo C, Bertin M, et al. Role of stapled and hand-sewn anastomoses in recurrence of Crohn’s disease. Hepatogastroenterology 2004;51(58):1053–7.PubMed

14.

Scarpa M, Ruffolo C, Bertin E, Polese L, Filosa T, Prando D, et al. Surgical predictors of recurrence of Crohn’s disease after ileocolonic resection. Int J Colorectal Dis 2007;22(9):1061–9.PubMedCrossRef

15.

Unkart JT, Anderson L, Li E, Miller C, Yan Y, Gu CC, et al. Risk factors for surgical recurrence after ileocolic resection of Crohn’s disease. Dis Colon Rectum 2008;51(8):1211–6.PubMedCrossRef

16.

Yamamoto T. Factors affecting recurrence after surgery for Crohn’s disease. World J Gastroenterol 2005;11(26):3971–9.PubMed

17.

Egan LJ, Sandborn WJ. Advances in the treatment of Crohn’s disease. Gastroenterology 2004;126(6):1574–81.PubMedCrossRef

18.

Cottone M, Orlando A, Modesto I. Postoperative maintenance therapy for inflammatory bowel disease. Curr Opin Gastroenterol 2006;22(4):377–81.PubMedCrossRef

19.

Markowitz J, Markowitz JE, Bousvaros A, Crandall W, Faubion W, Kirschner BS, et al. Workshop report: prevention of postoperative recurrence in Crohn’s disease. J Pediatr Gastroenterol Nutr 2005;41(2):145–51.PubMedCrossRef

20.

Li Y, Mao Q, Shen L, Tian Y, Yu C, Zhu WM, et al. Interleukin-23 receptor genetic polymorphisms and Crohn’s disease susceptibility: a meta-analysis. Inflamm Res;59(8):607–14.

21.

Lautenbach E, Berlin JA, Lichtenstein GR. Risk factors for early postoperative recurrence of Crohn’s disease. Gastroenterology 1998;115(2):259–67.PubMedCrossRef

22.

Rutgeerts P, Geboes K, Vantrappen G, Kerremans R, Coenegrachts JL, Coremans G. Natural history of recurrent Crohn’s disease at the ileocolonic anastomosis after curative surgery. Gut 1984;25(6):665–72.PubMedCrossRef

23.

Rutgeerts P, Geboes K, Vantrappen G, Beyls J, Kerremans R, Hiele M. Predictability of the postoperative course of Crohn’s disease. Gastroenterology 1990;99(4):956–63.PubMed

24.

Satsangi J, Silverberg MS, Vermeire S, Colombel JF. The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut 2006;55(6):749–53.PubMedCrossRef

25.

Cottone M, Rosselli M, Orlando A, Oliva L, Puleo A, Cappello M, et al. Smoking habits and recurrence in Crohn’s disease. Gastroenterology 1994;106(3):643–8.PubMed

26.

McLeod RS, Wolff BG, Ross S, Parkes R, McKenzie M. Recurrence of Crohn’s disease after ileocolic resection is not affected by anastomotic type: results of a multicenter, randomized, controlled trial. Dis Colon Rectum 2009;52(5):919–27.PubMedCrossRef

27.

Moskovitz D, McLeod RS, Greenberg GR, Cohen Z. Operative and environmental risk factors for recurrence of Crohn’s disease. Int J Colorectal Dis 1999;14(4–5):224–6.PubMedCrossRef

28.

Van Assche G, Dignass A, Reinisch W, van der Woude CJ, Sturm A, De Vos M, et al. The second European evidence-based Consensus on the diagnosis and management of Crohn’s disease: Special situations. J Crohns Colitis;4(1):63–101.

29.

Louis E, Collard A, Oger AF, Degroote E, Aboul Nasr El Yafi FA, Belaiche J. Behaviour of Crohn’s disease according to the Vienna classification: changing pattern over the course of the disease. Gut 2001;49(6):777–82.PubMedCrossRef

30.

Simillis C, Yamamoto T, Reese GE, Umegae S, Matsumoto K, Darzi AW, et al. A meta-analysis comparing incidence of recurrence and indication for reoperation after surgery for perforating versus nonperforating Crohn’s disease. Am J Gastroenterol 2008;103(1):196–205.PubMedCrossRef

31.

Sachar DB, Lemmer E, Ibrahim C, Edden Y, Ullman T, Ciardulo J, et al. Recurrence patterns after first resection for stricturing or penetrating Crohn’s disease. Inflamm Bowel Dis 2009;15(7):1071–5.PubMedCrossRef

32.

Greenstein AJ, Lachman P, Sachar DB, Springhorn J, Heimann T, Janowitz HD, et al. Perforating and non-perforating indications for repeated operations in Crohn’s disease: evidence for two clinical forms. Gut 1988;29(5):588–92.PubMedCrossRef

33.

Fritz T, Niederreiter L, Adolph T, Blumberg RS, Kaser A. Crohn’s disease: NOD2, autophagy and ER stress converge. Gut;60(11):1580–8.

34.

Ryan WR, Allan RN, Yamamoto T, Keighley MR. Crohn’s disease patients who quit smoking have a reduced risk of reoperation for recurrence. Am J Surg 2004;187(2):219–25.PubMedCrossRef

35.

Kurer MA, Stamou KM, Wilson TR, Bradford IM, Leveson SH. Early symptomatic recurrence after intestinal resection in Crohn’s disease is unpredictable. Colorectal Dis 2007;9(6):567–71.PubMedCrossRef

36.

Kane SV, Flicker M, Katz-Nelson F. Tobacco use is associated with accelerated clinical recurrence of Crohn’s disease after surgically induced remission. J Clin Gastroenterol 2005;39(1):32–5.PubMed

37.

Reese GE, Nanidis T, Borysiewicz C, Yamamoto T, Orchard T, Tekkis PP. The effect of smoking after surgery for Crohn’s disease: a meta-analysis of observational studies. Int J Colorectal Dis 2008;23(12):1213–21.PubMedCrossRef

38.

Aldhous MC, Drummond HE, Anderson N, Smith LA, Arnott ID, Satsangi J. Does cigarette smoking influence the phenotype of Crohn’s disease? Analysis using the Montreal classification. Am J Gastroenterol 2007;102(3):577–88.PubMedCrossRef

39.

Borley NR, Mortensen NJ, Jewell DP. Preventing postoperative recurrence of Crohn’s disease. Br J Surg 1997;84(11):1493–502.PubMedCrossRef

40.

Bitton A. Preventing postoperative recurrence in Crohn’s disease with 6-mercaptopurine and azathioprine: approaching the cutting edge. Inflamm Bowel Dis 2005;11(5):513–4.PubMedCrossRef

41.

Hashemi M, Novell JR, Lewis AA. Side-to-side stapled anastomosis may delay recurrence in Crohn’s disease. Dis Colon Rectum 1998;41(10):1293–6.PubMedCrossRef

42.

Ikeuchi H, Kusunoki M, Yamamura T. Long-term results of stapled and hand-sewn anastomoses in patients with Crohn’s disease. Dig Surg 2000;17(5):493–6.PubMedCrossRef

43.

Munoz-Juarez M, Yamamoto T, Wolff BG, Keighley MR. Wide-lumen stapled anastomosis vs. conventional end-to-end anastomosis in the treatment of Crohn’s disease. Dis Colon Rectum 2001;44(1):20–5; discussion 25–6.PubMedCrossRef

44.

Scott NA, Sue-Ling HM, Hughes LE. Anastomotic configuration does not affect recurrence of Crohn’s disease after ileocolonic resection. Int J Colorectal Dis 1995;10(2):67–9.PubMedCrossRef

45.

D’Haens GR, Vermeire S, Van Assche G, Noman M, Aerden I, Van Olmen G, et al. Therapy of metronidazole with azathioprine to prevent postoperative recurrence of Crohn’s disease: a controlled randomized trial. Gastroenterology 2008;135(4):1123–9.PubMedCrossRef

46.

Lochs H, Mayer M, Fleig WE, Mortensen PB, Bauer P, Genser D, et al. Prophylaxis of postoperative relapse in Crohn’s disease with mesalamine: European Cooperative Crohn’s Disease Study VI. Gastroenterology 2000;118(2):264–73.PubMedCrossRef

47.

Reinisch W, Angelberger S, Petritsch W, Shonova O, Lukas M, Bar-Meir S, et al. Azathioprine versus mesalazine for prevention of postoperative clinical recurrence in patients with Crohn’s disease with endoscopic recurrence: efficacy and safety results of a randomised, double-blind, double-dummy, multicentre trial. Gut;59(6):752–9.

48.

Cottone M, Mocciaro F, Orlando A. Infliximab prevents Crohn’s disease recurrence after ileal resection. Expert Rev Gastroenterol Hepatol 2009;3(3):231–4.PubMedCrossRef

49.

Regueiro M, Schraut W, Baidoo L, Kip KE, Sepulveda AR, Pesci M, et al. Infliximab prevents Crohn’s disease recurrence after ileal resection. Gastroenterology 2009;136(2):441–50 e1; quiz 716.PubMedCrossRef

50.

Sorrentino D, Terrosu G, Avellini C, Beltrami CA, Bresadola V, Toso F. Prevention of postoperative recurrence of Crohn’s disease by infliximab. Eur J Gastroenterol Hepatol 2006;18(4):457–9.PubMedCrossRef

51.

Yamamoto T, Nakahigashi M, Umegae S, Kitagawa T, Matsumoto K. Impact of long-term enteral nutrition on clinical and endoscopic recurrence after resection for Crohn’s disease: A prospective, non-randomized, parallel, controlled study. Aliment Pharmacol Ther 2007;25(1):67–72.PubMedCrossRef

52.

Blum E, Katz JA. Postoperative therapy for Crohn’s disease. Inflamm Bowel Dis 2009;15(3):463–72.PubMedCrossRef

53.

Colombel JF, Loftus EV, Jr., Tremaine WJ, Pemberton JH, Wolff BG, Young-Fadok T, et al. Early postoperative complications are not increased in patients with Crohn’s disease treated perioperatively with infliximab or immunosuppressive therapy. Am J Gastroenterol 2004;99(5):878–83.PubMedCrossRef

54.

Kennedy ED, To T, Steinhart AH, Detsky A, Llewellyn-Thomas HA, McLeod RS. Do patients consider postoperative maintenance therapy for Crohn’s disease worthwhile? Inflamm Bowel Dis 2008;14(2):224–35.PubMedCrossRef

55.

Olaison G, Smedh K, Sjodahl R. Natural course of Crohn’s disease after ileocolic resection: endoscopically visualised ileal ulcers preceding symptoms. Gut 1992;33(3):331–5.PubMedCrossRef

Title: Frequency and Risk Factors of Postoperative Recurrence of Crohn’s Disease After Intestinal Resection in the Chinese Population
Authors: Yi Li
Weiming Zhu
Lugen Zuo
Wei Zhang
Jianfeng Gong
Lili Gu
Lei Cao
Ning Li
Jieshou Li
Publication date: 01-08-2012
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 8/2012
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-012-1902-x

At a glance: The STEP trials

Springer Medicine

Frequency and Risk Factors of Postoperative Recurrence of Crohn’s Disease After Intestinal Resection in the Chinese Population

Abstract

Background

Materials and Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Materials and Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 8/2012

High Expression of CX3CL1/CX3CR1 Axis Predicts a Poor Prognosis of Pancreatic Ductal Adenocarcinoma

A Unique Variant of Afferent Limb Syndrome After Ileal Pouch–Anal Anastomosis: A Case Series and Review of the Literature

Impact of Lymphatic Vessel Invasion on Survival in Gastric Cancer

Unexpected Gallbladder Cancer after Laparoscopic Cholecystectomy for Acute Cholecystitis: A Worrisome Picture

Improved Quality of Life Following Total Pancreatectomy and Auto-islet Transplantation for Chronic Pancreatitis

Lymph Node Retrieval after Preoperative Chemoradiotherapy for Rectal Cancer