Could immunosuppressive drugs reduce recurrence rate after second resection for Crohn disease?
BACKGROUND
The aim of this study was to assess the possible benefit of postoperative immunosuppressive drugs administration (ie, azathioprine, 6-mercaptopurine, or methotrexate) on long-term surgical recurrence rate after second anastomotic ileocolonic resection.


METHODS
From 1984 to 2000, 26 patients with CD underwent second resection for ileocolonic anastomotic recurrence. There were 14 women and 12 men (mean age +/- SD: 34 +/- 9 years). Two groups of patients were compared according to the postoperative treatment: immunosuppressive (IS) drugs group was composed of 14 patients, and control group was composed of 12 patients receiving either salicylates (n = 5) or no treatment (n = 7).


RESULTS
Clinical recurrence rate at 3 years was significantly lower in the IS group than in the control group (3/12, 25% vs 6/10, 60%; P < 0.05). Although not significant, after a mean follow-up of 80 +/- 46 months (extr. 17-178 months) after the second resection, clinical recurrence rate at follow-up was also lower in IS group (6/14, 43%) than in control group (9/12, 75%). The mean delay of recurrence was similar in both groups (27 +/- 13 months vs 28 +/- 21; NS). A third intestinal resection was performed less frequently in the IS group than in control group (2/14, 17% vs 7/12, 58%; P < 0.02).


CONCLUSIONS
In patients treated with IS drugs, the rate of postoperative recurrence after second ileocolonic CD resection is lower than in untreated patients. Our results suggest that IS drugs should be evaluated prospectively for prevention of second postoperative CD recurrence.
Department of Surgery, Lariboisière University Hospital, Paris, France.
Arnaud
A
Alves
Yves
Y
Panis
Francisca
F
Joly
Marc
M
Pocard
Anne
A
Lavergne-Slove
Yoram
Y
Bouhnik
Patrice
P
Valleur
D000328:Adult; D001379:Azathioprine / Q000627:therapeutic use; D003106:Colon / Q000601:surgery; D003424:Crohn Disease / Q000188:drug therapy* / Q000601:surgery*; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D007082:Ileum / Q000601:surgery; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D015122:Mercaptopurine / Q000627:therapeutic use; D008727:Methotrexate / Q000627:therapeutic use; D011182:Postoperative Care; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome
D005765:Gastrointestinal Agents; D007166:Immunosuppressive Agents; D015122:Mercaptopurine; D001379:Azathioprine; D008727:Methotrexate