Prediction of early symptomatic recurrence after intestinal resection in Crohn's disease.
OBJECTIVE
This study was performed to identify clinical criteria that may help recognize patients with Crohn's disease who are at high risk for early symptomatic postoperative recurrence.


BACKGROUND
Currently, no reliable criteria are available to help recognize patients who are prone to experience early symptomatic recurrence.


METHODS
One hundred sixty-four patients undergoing intestinal resection for Crohn's disease at the Mount Sinai Hospital between 1976 and 1989 were studied prospectively. Patients with symptomatic recurrent disease within 36 months were defined as having an early recurrence.


RESULTS
Multivariate analysis revealed that the number of anastomoses was the most important prognostic indicator (p = 0.001), followed by inflammation at the resection margins (p < 0.05). Patients requiring an ileostomy had a significantly lower early recurrence rate than those having single or multiple anastomoses. There was no significant correlation between inflammation at the margins and early recurrence in patients requiring an ileostomy (n = 38), or a single anastomosis (n = 98). When the margins were examined in the 28 patients with 2 or more anastomoses, 10 of 11 patients (91%) with inflammation at either margin experienced early recurrence. Patients having multiple anastomoses with normal margins had the same recurrence rate as patients with single anastomosis (42%).


CONCLUSIONS
Patients with extensive Crohn's disease requiring multiple resections with anastomosis, especially when microscopic inflammation is present at the margins, are at very high risk for symptomatic early recurrence. Ileostomy seems to be associated with a significantly lower early recurrence potential than anastomosis. Further study is needed to determine whether avoidance of multiple anastomosis and adjuvant medical treatment can alter the course of the disease after intestinal resection in patients at high risk for early symptomatic recurrence.
Heimann
T M
TM
Department of Surgery, Mount Sinai School of Medicine, New York, New York.
Greenstein
A J
AJ
Lewis
B
B
Kaufman
D
D
Heimann
D M
DM
Aufses
A H
AH
D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D002648:Child; D002675:Child, Preschool; D003106:Colon / Q000601:surgery; D003424:Crohn Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D007081:Ileostomy; D007082:Ileum / Q000601:surgery; D007223:Infant; D007420:Intestine, Large / Q000601:surgery*; D007421:Intestine, Small / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence