Re-resection rates & disease recurrence CD

August 12, 2024

Issue 16

Clinical Question

What are the rates of clinical and surgical recurrence after primary resection for Crohn’s disease (CD) and what factors impact these rates?

Editor’s Bottom Line

Disease recurrence and reoperation are common after primary resection for CD, but their rates may be attenuated by prophylactic medical therapy.

Reference

Poulsen A, Rasmussen J, Wewer MD, et al. Re-resection Rates and Disease Recurrence in Crohn’s Disease: A Population-based Study Using Individual-level Patient Data. https://academic.oup.com/ecco-jcc/advance-article

Synopsis

A retrospective, population-based, individual patient-level data cohort study representing 47.4% of the Danish population reviewed individual patient records of all CD patients who underwent a primary resection between 2010 and 2020.

The median age at diagnosis was 28.2 years, 37% were active smokers, and 51% were men. Most patients presented with stricturing disease at the time of diagnosis (45%). The median time from diagnosis to end of follow-up was 118 months, and 75 months from primary resection to end of follow-up.

Among 631 patients included in the analysis, 24.5% underwent a second resection, and 5.3% a third. The re-resection rates were 12.6%, 22.4%, and 32.2%, after 1, 5, and 10 years, respectively. With respect to resections driven by disease activity, rates after 1, 5, and 10 years were 3.6%, 10.1%, and 14.1%, respectively.

Postoperative disease recurrence (PDR) rates were 36.9% at 1 year, 66.1% at 5 years, and 73.6% at 10 years. PDR was defined as endoscopic or radiologic disease activity, abnormal fecal calprotectin, requirement for corticosteroids or resection due to disease activity. Most stoma reversals (80%) occurred within 1 year. The median time from primary resection to PDR was 11.0 months. Five years after the primary resection, the recurrence rate reached a plateau of 74%.

Sub-group analyses to identify factors modifying postoperative disease found that prophylactic biologic therapy after primary ileocaecal resection significantly reduced both disease recurrence and re-resection (hazard ratio 0.58, 95% confidence interval [CI] [0.34–0.99], p=0.047). Other risk factors for re-resection included primary colonic resection, isolated small bowel disease, B1 disease behaviour, smoking, and perianal disease.

Details

Study Design: Population-based cohort
Funding: None
Allocation: Not applicable
Setting: Multicenter
Level of Evidence: 2b