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Title: Short- and medium-term outcomes following primary ileocaecal resection for Crohn's disease in two specialist centres
Authors: van Overstraeten, Anthony de Buck
Eshuis, Emma J.
Vermeire, Séverine
Van Assche, Gert A.
Ferrante, M.
D'Haens, G. R.
Ponsioen, Cyriel Y.
Belmans, Ann
Buskens, Christianne J.
Wolthuis, Albert M.
Bemelman, Willem A.
D'Hoore, André
Issue Date: 2017
Publisher: WILEY
Source: BRITISH JOURNAL OF SURGERY, 104(12), p. 1713-1722
Abstract: 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.
Notes: [van Overstraeten, A. de Buck; Wolthuis, A. M.; D'Hoore, A.] Katholieke Univ Leuven, Univ Hosp Leuven, Dept Abdominal Surg, Herestr 49, B-3000 Leuven, Belgium. [Vermeire, S.; Van Assche, G.; Ferrante, M.] Katholieke Univ Leuven, Univ Hosp Leuven, Dept Gastroenterol & Hepatol, Leuven, Belgium. [Belmans, A.] Univ Leuven, KU Leuven, Leuven, Belgium. [Belmans, A.] Univ Hasselt, Biostat 1, Leuven, Belgium. [Eshuis, E. J.; D'Haens, G. R.; Ponsioen, C. Y.] Acad Med Ctr, Dept Gastroenterol, Amsterdam, Netherlands. [Buskens, C. J.; Bemelman, W. A.] Acad Med Ctr, Dept Gen Surg, Amsterdam, Netherlands.
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ISSN: 0007-1323
e-ISSN: 1365-2168
DOI: 10.1002/bjs.10595
ISI #: 000413157100016
Rights: © 2017 BJS Society Ltd Published by John Wiley & Sons Ltd
Category: A1
Type: Journal Contribution
Validations: ecoom 2018
Appears in Collections:Research publications

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