Case Control Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. Oct 15, 2019; 10(4): 67-74
Published online Oct 15, 2019. doi: 10.4292/wjgpt.v10.i4.67
Risk factors for recurrence after bowel resection for Crohn’s disease
Ze-Xian Chen, Yong-Le Chen, Xiao-Ming Huang, Xu-Tao Lin, Xiao-Wen He, Ping Lan
Ze-Xian Chen, Yong-Le Chen, Xiao-Wen He, Ping Lan, Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510655, Guangdong Province, China
Xiao-Ming Huang, Department of Hepatobiliary Surgery, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510655, Guangdong Province, China
Xu-Tao Lin, Department of Endoscopy Center, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510655, Guangdong Province, China
Author contributions: Chen ZX and Chen YL contributed equally to this work; all the authors contributed to the conception and design of the study; Chen ZX and Chen YL contributed to the collection of data; Huang XM and Lin XT contributed to the analysis and interpretation of the data; Chen ZX and Chen YL contributed to drafting the manuscript; He XW and Lan P contributed to critical revision of the manuscript for important intellectual content; all of the authors approved the final draft of the article.
Supported by Science and Technology Planning Project of Guangdong Province, No. 20160916; Medical Science Research Grant from the Health Department of Guangdong Province, No. A2018007.
Institutional review board statement: The study was approved by the ethics committee of the Sixth Affiliated Hospital, Sun Yat-Sen University.
Informed consent statement: All patients gave informed consent.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
STROBE statement: The authors have read the STROBE Statement, and the manuscript was prepared and revised according to the STROBE Statement.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Ping Lan, PhD, Professor, Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-Sen University, 26 Yuancun Erheng Road, Guangzhou 510655, Guangdong Province, China. sumslp@163.com
Telephone: +86-20-38254009 Fax: +86-20-38254009
Received: May 16, 2019
Peer-review started: May 23, 2019
First decision: August 1, 2019
Revised: August 12, 2019
Accepted: September 20, 2019
Article in press: September 20, 2019
Published online: October 15, 2019
Abstract
BACKGROUND

Complications of Crohn’s disease such as intestinal obstruction, fistula or perforation often need surgical treatment. Nearly 70%-80% patients with Crohn’s disease would receive surgical treatment during the lifetime. However, surgical treatment is incurable for Crohn’s disease. The challenge of recurrence postoperatively troubles both doctors and patients. Over 50% patients would suffer recurrence postoperatively. Some certain risk factors are associated with recurrence of Crohn’s disease.

AIM

To evaluate the risk factors for endoscopic recurrence and clinical recurrence after bowel resection in Crohn’s disease.

METHODS

Patients diagnosed Crohn’s disease and received intestinal resection between April 2007 and December 2013 were included in this study. Data on the general demographic information, preoperative clinical characteristics, surgical information, postoperative clinical characteristics were collected. Continuous data are expressed as median (inter quartile range), and categorical data as frequencies and percentages. Kaplan-Meier method was applied to estimate the impact of the clinical variables above on the cumulative rate of postoperative endoscopic recurrence and clinical recurrence, then log-rank test was applied to test the homogeneity of those clinical variables. Multivariate Cox proportional hazard regression analysis was performed to identify the risk factors of postoperative endoscopic recurrence and clinical recurrence.

RESULTS

A total of 64 patients were included in this study. The median follow-up time for the patients was 17 (9.25-25.75) mo. In this period, 41 patients (64.1%) had endoscopic recurrence or clinical recurrence. Endoscopic recurrence occurred in 34 (59.6%) patients while clinical recurrence occurred in 28 (43.8%) patients, with the interval between the operation and recurrence of 13.0 (8.0-24.5) months and 17.0 (8.0-27.8) mo, respectively. In univariate analysis, diagnosis at younger age (P < 0.001), disease behavior of penetrating (P = 0.044) and preoperative use of anti-tumor necrosis factor (TNF) (P = 0.020) were significantly correlated with endoscopic recurrence, while complication with perianal lesions (P = 0.032) and preoperative use of immunomodulatory (P = 0.031) were significantly correlated with clinical recurrence. As to multivariate analysis, diagnostic age (P = 0.004), disease behavior (P = 0.041) and preoperative use of anti-TNF (P = 0.010) were independent prognostic factors for endoscopic recurrence, while complication with perianal lesions (P = 0.023) was an independent prognostic factor for clinical recurrence.

CONCLUSION

Diagnostic age, disease behavior, preoperative use of anti-TNF and complication with perianal lesions were independent risk factors for postoperative recurrence in Crohn’s disease.

Keywords: Risk factor, Endoscopic recurrence, Clinical recurrence, Bowel resection, Crohn’s disease

Core tip: Our study aimed at evaluating the risk factors for recurrence after bowel resection in Crohn’s disease. This study included 64 patients diagnosed Crohn’s disease and received intestinal resection. The result showed that diagnosis at younger age, disease behavior of penetrating and preoperative use of anti-tumor necrosis factor were independent prognostic factors for endoscopic recurrence, while complication with perianal lesions was an independent prognostic factor for clinical recurrence.