Published online Oct 15, 2019. doi: 10.4292/wjgpt.v10.i4.67
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
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.
A great amount of patients with Crohn’s disease would receive surgical treatment but over one half patients would suffer recurrence postoperatively. It is important to recognize the risk factor for postoperative recurrence. Further clinical research base on certain risk factor would favor the prognosis.
This study aims to evaluate the risk factor of endoscopic recurrence and clinical recurrence after bowel resection for Crohn’s disease. Further relative clinical research could focus on the risk factor found in this study and help to improve the prognosis for certain patients.
Patients diagnosed Crohn’s disease and received intestinal resection 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.
Diagnosis at younger age, disease behavior of penetrating and preoperative use of anti-tumor necrosis factor (TNF) were significantly correlated with endoscopic recurrence, while complication with perianal lesions and preoperative use of immunomodulatory were significantly correlated with clinical recurrence. As to multivariate analysis, diagnostic age, disease behavior and preoperative use of anti-TNF were independent prognostic factors for endoscopic recurrence, while complication with perianal lesions was an independent prognostic factor for clinical recurrence. The result of this study discovered some risk factors for recurrence in patients with Crohn’s disease after bowel resection. Prospective clinical study with more patients remains to be performed to confirm the result.
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. Patients with younger diagnostic age, disease behavior of penetrating and preoperative use of anti-TNF tended to have endoscopic recurrence, while patients with perianal lesions tended to suffer from clinical recurrence. Some certain factors are associated with postoperative recurrence of Crohn’s disease. In this study, diagnostic age, disease behavior, preoperative use of anti-TNF and complication with perianal lesions were proved as independent prognostic factors. The recurrence rate of Crohn’s disease after bowel resection is high and some certain clinical factors have been proved associated with postoperative recurrence. In this study, we found diagnostic age, disease behavior and preoperative use of anti-TNF were independent prognostic factors for endoscopic recurrence, while complication with perianal lesions was an independent prognostic factor for clinical recurrence. Diagnostic age, disease behavior, preoperative use of anti-TNF and complication with perianal lesions were related with postoperative recurrence in Crohn’s disease. This study adopts the classical methods. 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) mo and 17.0 (8.0-27.8) mo, respectively. Diagnostic age, disease behavior and preoperative use of anti-TNF were independent prognostic factors for endoscopic recurrence, while complication with perianal lesions was an independent prognostic factor for clinical recurrence. Diagnostic age, disease behavior, preoperative use of anti-TNF and complication with perianal lesions were related with postoperative recurrence in Crohn’s disease. Patients with such risk factors should be strictly followed up and receive appropriate medical therapy if necessary.
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. Prospective clinical study with more patients remains to be performed to confirm the results. Prospective clinical trial with multi centers and more patients would be the best method for future research.