Risk factors for postoperative recurrence after primary bowel resection in patients with Crohn’s disease

Table 1 Demographic and clinical characteristics of the patients undergoing intestinal resection n (%)

Variables	Number of patients
	(n = 260)
SEX
Male	187 (71.9)
Female	73 (28.1)
Follow-up period, month	101 (12-193)
Age at diagnosis	23 (12-74)
Age at 1st operation	28 (15-74)
Age at 2nd operation	34 (22-59)
Montreal classification
Age at diagnosis, yr
A1 ( ≤ 16)	25 (9.6)
A2 (17-40)	215 (82.7)
A3 ( > 40)	20 (7.7)
Location
L1 (Terminal ileum)	113 (43.5)
L2 (Colon)	38 (14.6)
L3 (Ileocolon)	107 (41.2)
L4 (Isolated upper disease)	2 (0.8)
Behavior
B1 (Inflammatory)	6 (2.3)
B2 (Stricturing)	80 (30.8)
B3 (Penetrating)	174 (66.9)
Family history (Crohn's disease)	7 (2.7)
Presence of extraintestinal manifestation	20 (7.7)
Perianal disease
at diagnosis	122 (46.9)
after 1st operation	62 (23.8)
History of smoking	70 (26.9)
Current smoker	12 (4.6)
Ex-smoker	58 (22.3)
Non-smoker	190 (73.1)
Preoperative use of medication
Anti-TNF	27 (10.4)
5-ASA	223 (85.8)
Steroid	147 (56.5)
Immunomodulator1	128 (49.2)
Antibiotics2	128 (49.2)
Malignancy	163 (62.7)
Colorectal cancer	3 (1.2)
Lung cancer	1 (0.4)

¹Use of azathioprine/6-mercaptopurine or methotrexate;

²Ciprofloxacin or metronidazole. EIM: Extraintestinal manifestation; 5-ASA: Aminosalicylates; TNF: Tumor necrosis factor.

Table 2 Operative details and outcomes n (%)

Variables	Number of patients
	(n = 266)
Operative approach
Open	215 (82.7)
Laparoscopy	45 (17.3)
Type of operation
Elective	210 (80.8)
Emergency	50 (19.2)
Indication for 1st operation
Perforating	167 (64.2)
Non-perforating	93 (35.8)
OP name
ICR	85 (32.7)
RHC	72 (27.7)
SB R&A	49 (18.8)
TC/STC	32 (12.3)
TPC/APR	19 (7.3)
Others	3 (1.2)
Type of anastomosis
Handsewn	5 (1.9)
Stapled	225 (86.5)
Permanent stomy	28 (10.8)
Postoperative use of medication
Anti-TNF	95 (36.5)
5-ASA	244 (93.8)
Steroid	82 (31.5)
Immunomodulator	220 (84.6)
Presence of complication	58 (22.3)
Wound infection	17 (6.5)
Anastomosis leakage	12 (4.6)
Intra-abdominal abscess	11 (4.2)
Entero-cutaneous fistula	7 (2.7)
Bleeding	4 (1.5)
Ileus	3 (1.2)
Others	4 (1.5)
Time to clinical recurrence, mo	64 ± 29.8
Time to surgical recurrence, mo	77.5 ± 30.8

ICR: Ileocecal resection; RHC: Right hemicolectomy; SB R&A: Small bowel resection and anastomosis; TC: Total colectomy; STC: Subtotal colectomy; TPC: Total proctocolectomy; Others: Segmental resection of colon.

Table 3 Univariate and multivariate analysis of factors associated with surgical and clinical recurrence free survival after 1st intestinal resection

	Univariate		Multivariate
	P value	HR	95%CI	P value
Clinical recurrence free survival
Type of operation	0.001a			0.002a
Elective		1
Emergency		1.856	1.246-2.763
Perianal disease after the 1st operation	0.077	1.446	1.005-2.081	0.047a
History of smoking	0.001a	1.727	1.220-2.444	0.002a
Surgical recurrence free survival
Age at diagnosis, yr	0.097			0.065
A1 ( ≤ 16)		3.512	0.944-13.068
A2 ( 17-40)		1.547	0.475-5.036
A1 ( > 40)
Type of operation	0.001a			0.002a
Elective		1
Emergency		2.431	1.394-4.240
Perianal disease after the 1st operation	0.056	1.715	1.005-2.926	0.048a
History of smoking	0.047a	1.798	1.088-2.969	0.022a
Postoperative use of anti-TNF	0.016a	0.521	0.300-0.904	0.02a

^aP < 0.05; HR: Hazard ratio.