Published online Oct 14, 2017. doi: 10.3748/wjg.v23.i38.7016
Peer-review started: July 27, 2017
First decision: August 10, 2017
Revised: August 24, 2017
Accepted: September 13, 2017
Article in press: September 13, 2017
Published online: October 14, 2017
To evaluate the risk factors for postoperative recurrence after primary bowel resection in a cohort of Korean Crohn’s disease (CD) patients.
This study included 260 patients with no history of previous bowel surgery who underwent primary surgery for CD between January 2000 and December 2010 at Asan Medical Center (Seoul, South Korea). The median follow-up period was 101 mo.
During the follow-up period, 66 patients (25.4%) underwent a second operation for disease recurrence. At 1, 5 and 10 years after the first operation, the cumulative rate of surgical recurrence was 1.1%, 8.3% and 35.9% and clinical recurrence occurred in 1.2%, 23.6% and 68.1%, respectively. In multivariate analysis, undergoing an emergency operation was a significant risk factor for surgical recurrence-free survival (SRFS) [HR = 2.431, 95%CI: 1.394-4.240, P = 0.002], as were the presence of perianal disease after the first operation (HR = 1.715, 95%CI: 1.005-2.926, P = 0.048) and history of smoking (HR = 1.798, 95%CI: 1.088-2.969, P = 0.022). The postoperative use of anti-tumor necrosis factor (TNF) agents reduced SRFS risk (HR = 0.521, 95%CI: 0.300-0.904, P = 0.02).
History of smoking, postoperative perianal disease and undergoing an emergency operation were independent risk factors for surgical recurrence. Using anti-TNF agents may reduce surgical recurrence.
Core tip: Our study demonstrated the clinical feature and long-term prognosis of Crohn’s disease (CD) in a large cohort of non-Caucasian patients. We investigated risk factors for the postoperative recurrence of CD in a patient population from a single tertiary referral center. History of smoking, postoperative perianal disease and undergoing an emergency operation were found to be independent risk factors for surgical recurrence in CD. Using anti-TNF agents for these patients may reduce surgical recurrence. These findings indicate that affected patients with CD may benefit from close postoperative surveillance and probably from the early administration of anti-TNF agents.