[Crohn's disease surgery: problems of postoperative recurrence].
Crohn's disease is associated with high rates of postoperative recurrence. By 10 years postoperatively a high percentage of patients suffer clinical relapses (as many as 75% and above) and many of these (up to 45%) require re-intervention. The aim of the study was to identify, among the various potentially predictive factors, those which today can be considered real risk factors for postoperative recurrence. A review of the literature of the last two decades was carried out. Factors related to the patient, disease, type of surgery and pharmacological treatment were analysed. The relapse rate we recorded was 41.17% (28 of 62 patients operated on in the last 20 years and included in an average 6-year follow-up (range: 1-19 years). Significant predictive factors, in adition to duration of the follow-up and smoking, are also the location of the disease in the colon, extent more than 100 cm and the absence of postoperative pharmacological prophylaxis. The high incidence of postoperative recurrence in Crohn's disease mandates a strict follow-up (clinical, laboratory and instrumental monitoring). Identifying patients at increased risk would enable physicians to implement a rational pharmacological prophylaxis.
Fornaro
Rosario
R
Patologia Chirurgica a Indirizzo Gastroenterologico, Dipartimento di Discipline Chirurgiche e Metodologie Integrate, Università degli Studi di Genova.
Frascio
Marco
M
Stabilini
Cesare
C
Sticchi
Camilla
C
Barberis
Andrea
A
Denegri
Andrea
A
Ricci
Barbara
B
Azzinnaro
Antonio
A
Lazzara
Fabrizio
F
Gianetta
Ezio
E
D000293:Adolescent; D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000627:therapeutic use; D003424:Crohn Disease / Q000188:drug therapy* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000069285:Infliximab; D010535:Laparoscopy; D008297:Male; D019804:Mesalamine / Q000008:administration & dosage / Q000627:therapeutic use; D008795:Metronidazole / Q000008:administration & dosage / Q000627:therapeutic use; D008875:Middle Aged; D011182:Postoperative Care; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
D000890:Anti-Infective Agents; D000893:Anti-Inflammatory Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D007166:Immunosuppressive Agents; D008795:Metronidazole; D019804:Mesalamine; D000069285:Infliximab