Recurrence after abdominal surgery for Crohn's disease: relationship to disease site and surgical procedure.
OBJECTIVE
We investigated the hypothesis that there is an "aggressive" subtype of Crohn's disease characterized by early recurrence and that disease location and surgical procedure are associated with differing patterns of recurrence.


METHODS
We analyzed 280 patient records totaling 482 major abdominal operations from a prospectively compiled Crohn's disease database. Patterns of recurrence, as defined by reoperation, were analyzed by Kaplan-Meier plots and log-rank tests for the group as a whole, as well as according to disease location and operation performed using log-rank and Cox regression analysis.


RESULTS
The overall survival curve followed a simple curve with no apparent early rise in recurrence. There was a significantly higher recurrence rate for ileal disease than for ileocolic or colic disease (median reoperation-free survival, 37.8 vs. 47.8 and 54.7 months, respectively; log-rank test = 13.6; P = 0.001), and there was a significantly shorter reoperation-free survival for those patients treated by strictureplasty alone or stricture-plasty combined with resection than for those treated by resection alone (41.7 and 48.6 vs. 51 months, respectively; log-rank test = 12; P = 0.002), but only disease site was confirmed as an independent risk factor for recurrence by multiple regression analysis.


CONCLUSIONS
These data suggest that there is no evidence for the existence of a separate, early recurring, aggressive disease type. Shorter reoperation-free survival after strictureplasty may reflect patterns of recurrence in ileal disease.
Borley
Neil R
NR
Department of Colorectal Surgery, John Radcliffe Hospital, Oxford, United Kingdom.
Mortensen
Neil J McC
NJ
Chaudry
Mohammed A
MA
Mohammed
Said
S
Warren
Bryan F
BF
George
Bruce D
BD
Clark
Taane
T
Jewell
Derek P
DP
Kettlewell
Michael G W
MG
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003106:Colon / Q000601:surgery*; D003424:Crohn Disease / Q000209:etiology / Q000401:mortality* / Q000601:surgery*; D013505:Digestive System Surgical Procedures; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors