Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Feb 27, 2024; 16(2): 429-437
Published online Feb 27, 2024. doi: 10.4240/wjgs.v16.i2.429
Short- and long-term outcomes of surgical treatment in patients with intestinal Behcet’s disease
Min Young Park, Yong Sik Yoon, Jae Ha Park, Jong Lyul Lee, Chang Sik Yu
Min Young Park, Division of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul 03722, South Korea
Yong Sik Yoon, Jae Ha Park, Jong Lyul Lee, Chang Sik Yu, Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
Author contributions: Park MY designed and performed the research and wrote the paper; Yoon YS designed the research and supervised the report; Park JH collected the data; Lee JL and Yu CS provided clinical advice and supervised the report.
Institutional review board statement: The study protocol was approved by the institutional review board of Asan Medical Center (approval No. 2022-0238).
Informed consent statement: This study is retrospective study and use anonymous data, and Institutional Review Board of Asan Medical Center approved study and waived informed consent.
Conflict-of-interest statement: All authors have no conflict of interest related to the manuscript.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yong Sik Yoon, MD, PhD, Professor, 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. yoonys@amc.seoul.kr
Received: October 17, 2023
Peer-review started: October 17, 2023
First decision: November 1, 2023
Revised: November 29, 2024
Accepted: January 15, 2024
Article in press: January 15, 2024
Published online: February 27, 2024
Abstract
BACKGROUND

Behcet’s disease (BD), a chronic vasculitic disorder affecting multiple organs, is characterized by recurrent oral and genital ulcers, arthritis, vasculitis, and intestinal ulcers. Although intestinal involvement of BD is common in East Asia, the efficacy and long-term outcomes of surgical treatment of intestinal BD still remain to be established.

AIM

To evaluate the postoperative clinical course of intestinal BD and determine factors associated with its recurrence.

METHODS

Data from patients who underwent surgical treatment for intestinal BD between January 2010 and August 2021 were retrospectively reviewed. Patients’ demographics, clinical features, postoperative course, complications, and follow-up data were evaluated.

RESULTS

We analyzed 39 surgeries in 31 patients. The mean patient age was 45.1 years, and the mean interval between the diagnosis of intestinal BD and surgical treatment was 4.9 years (range 1.0-8.0 years). The most common indication for surgery was medical intractability (n = 16, 41.0%), followed by fistula or abscess (n = 11, 28.2%). Laparoscopic approaches were used in 19 patients (48.7%), and 5 patients (12.8%) underwent emergency surgeries. The most common surgical procedure was ileocecal resection (n = 18, 46.2%), followed by right colectomy (n = 11, 28.2%). A diverting stoma was created in only one patient (2.6%). During a mean follow-up period of 45 (range 8-72) months, eight cases (20.5%) of recurrence in five patients required reoperation. The interval between operations was 12.1 months (range 6.3-17.8 mo). Four patients (10.3%) experienced recurrence within 1 year postoperatively, and all eight recurrences occurred within 2 years of the initial surgery. The reoperation rates at 1 and 3 years were 10.3% and 20.5%, respectively. A redo ileocolic anastomosis was performed in all recurrent cases. In multivariate Cox regression analysis, emergency surgery [hazard ratio (HR) 9.357, 95% confidence interval (CI): 1.608-54.453, P = 0.013] and elevated C-reactive protein (CRP) levels (HR 1.154, 95%CI: 1.002–1.328, P = 0.047), but not medication use, were predictors of recurrence.

CONCLUSION

Surgical resection is a feasible treatment option for complicated BD. Reoperation is associated with severe inflammatory conditions, reflected by increased CRP levels and the requirement for emergency surgery.

Keywords: Behcet syndrome, Intestinal, General surgery, Recurrence, Risk factors

Core Tip: Behcet's disease (BD), a chronic vasculitic disorder impacting multiple organs, often necessitates surgical intervention due to medical intractability, fistulas, or abscesses. This study examined 31 patients who underwent surgery for intestinal BD. Recurrence occurred in 20.5% of cases, with all instances happening within two years after surgery. Emergency surgery and elevated C-reactive protein (CRP) levels were predictive of recurrence. This suggests that surgical resection is a viable option for complicated BD, but reoperation is more likely in patients with severe inflammation as indicated by elevated CRP levels and the requirement for emergency surgery.