The impact of clinical types of disease manifestation on the risk of early postoperative recurrence in Crohn's disease.
OBJECTIVE
Surgery for Crohn's disease is frequently followed by symptomatic recurrence, which in up to 40% requires reoperation within 6 years. Whilst there is evidence that postoperative medical prophylaxis can be efficient, the results of clinical trials are inconsistent regarding the achieved benefit for the patient. Several parameters have been claimed to indicate an increased intrinsic risk of early surgical recurrence.


METHODS
Patient charts of 287 patients who had undergone abdominal surgery for Crohn's disease were reviewed. Mean follow-up was 4.4 years. Recurrence-free intervals were calculated by the Kaplan-Meier method. A uni- and multivariate analysis was conducted to assess the impact of possible indicators of the need of repeated surgery.


RESULTS
Patients with fistulizing type of symptoms, extraintestinal manifestations, corticosteroid treatment or male gender experienced significantly earlier reoperation. Recurrent disease, histologic evidence of inflamed resection margins, patient's age at the time of primary diagnosis and operation and the presence of epitheloid granulomas did not show significant influence on recurrence-free intervals.


CONCLUSIONS
We conclude that the natural course of disease after intestinal resection in patients with one or more of these risk factors tends towards earlier recurrence requiring surgical intervention. The risk factors identified in this trial may be useful for patient stratification for randomized trials on the efficacy of medical prophylaxis.
Dept. of General and Abdominal Surgery, University of Mainz, Mainz, Germany. drbhofer@aol.com
B
B
Hofer
T
T
Böttger
T
T
Hernandez-Richter
J K
JK
Seifert
T
T
Junginger
D000328:Adult; D003424:Crohn Disease / Q000150:complications / Q000473:pathology / Q000601:surgery*; D005260:Female; D005355:Fibrosis; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007249:Inflammation; D007412:Intestinal Fistula / Q000150:complications; D007415:Intestinal Obstruction / Q000150:complications; D007422:Intestines / Q000473:pathology / Q000601:surgery; D008297:Male; D015999:Multivariate Analysis; D012008:Recurrence; D019233:Retreatment; D012189:Retrospective Studies; D012307:Risk Factors
D005938:Glucocorticoids