Recurrence and impact of postoperative prophylaxis in laparoscopically treated primary ileocolic Crohn disease.
OBJECTIVE
To define risk factors for recurrence and to determine whether postoperative prophylaxis would influence time to recurrence after primary laparoscopic ileocolectomy for Crohn disease.


METHODS
Retrospective record review.


METHODS
Tertiary academic medical center.


METHODS
All patients who underwent primary laparoscopic ileocolectomy for terminal ileal Crohn disease between April 28, 1994, and August 3, 2006, at the Mayo Clinic, Rochester, Minnesota.


METHODS
All patients were reviewed for follow-up, recurrence, risk factors for recurrence, and use of postoperative immunosuppressive prophylaxis.


RESULTS
One hundred nine patients were identified, of whom 89 were followed up postoperatively at Mayo Clinic with a median follow-up of 3.5 years (range, 1.8 months to 11.9 years). Recurrence was discovered in 54 patients (61%) at a median of 13.1 months (range, 1.3 months to 8.7 years). Forty-four patients (49%) received postoperative immunosuppressive prophylaxis (37 [42%] received azathioprine, 8 [9%] received 6-mercaptopurine, and 3 [3%] received infliximab). In a multivariate model of various risk factors for recurrence, presence of granulomas was the only significant predictor of recurrence (P = .01). The 2-year cumulative recurrence rates in the prophylaxis and nonprophylaxis groups were 37.5% and 52.6%, respectively (log-rank test, P = .87).


CONCLUSIONS
Recurrence occurred in more than half of the patients with Crohn disease after primary laparoscopic ileocolectomy. In this highly selected patient population, use of immunosuppressive prophylaxis was not associated with a delay in recurrence. Presence of granulomas was the only significant predictor of recurrence. These findings should be further explored in larger and less selected patient populations.
Malireddy
Kishore
K
Division of Colorectal Surgery, Mayo Clinic, Rochester, MN 55905, USA.
Larson
David W
DW
Sandborn
William J
WJ
Loftus
Edward V
EV
Faubion
William A
WA
Pardi
Darrell S
DS
Qin
Rui
R
Gullerud
Rachel E
RE
Cima
Robert R
RR
Wolff
Bruce
B
Dozois
Eric J
EJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D003424:Crohn Disease / Q000188:drug therapy / Q000517:prevention & control / Q000601:surgery*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007079:Ileitis / Q000188:drug therapy / Q000517:prevention & control / Q000601:surgery*; D007155:Immunologic Factors / Q000008:administration & dosage; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D055815:Young Adult
D007155:Immunologic Factors