Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 14, 2017; 23(38): 7016-7024
Published online Oct 14, 2017. doi: 10.3748/wjg.v23.i38.7016
Risk factors for postoperative recurrence after primary bowel resection in patients with Crohn’s disease
Kwan Mo Yang, Chang Sik Yu, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, In Ja Park, Seok-Byung Lim, Sang Hyoung Park, Byong Duk Ye, Suk-Kyun Yang, Jin Cheon Kim
Kwan Mo Yang, Chang Sik Yu, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, In Ja Park, Seok-Byung Lim, Jin Cheon Kim, Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
Sang Hyoung Park, Byong Duk Ye, Suk-Kyun Yang, Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
Author contributions: Yang KM drafted the manuscript and analyzed data; Lee JL, Kim CW, Yoon YS, Park IJ, Lim SB, Park SH, Ye BD, Yang SK, Kim JC generated the data; Yu CS had the original idea for the paper, gave critical comments, and revised the manuscript; all authors approved the final version of the manuscript.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Asan Medical Center (IRB No. 2016-1139).
Informed consent statement: Informed consent was waived due to the retrospective nature of this study.
Conflict-of-interest statement: All authors declare no conflict of interest related to this study or its publication.
Data sharing statement: No additional data are available.
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/
Correspondence to: Chang Sik Yu, MD, PhD, Professor, The Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea. csyu@amc.seoul.kr
Telephone: +82-2-30103494 Fax: +82-2-4746027
Received: July 23, 2017
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
Processing time: 84 Days and 22.7 Hours
Abstract
AIM

To evaluate the risk factors for postoperative recurrence after primary bowel resection in a cohort of Korean Crohn’s disease (CD) patients.

METHODS

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.

RESULTS

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).

CONCLUSION

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.

Keywords: Crohn’s disease; Recurrence; Risk factor

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.