title: Repeat intestinal resections increase the risk of recurrence of Crohn's disease.
abstract: BACKGROUND
  Which factors predict recurrence in patients with Crohn's disease in the era of immunosuppressive medications is still under debate.
  
  
  OBJECTIVE
  The current study was conducted to assess long-term outcome after ileocolic resection for Crohn's disease and to define predictive factors for surgical relapse.
  
  
  METHODS
  This is a retrospective study.
  
  
  METHODS
  The study was conducted in a tertiary referral center.
  
  
  METHODS
  A consecutive cohort of patients (n = 203) with Crohn's disease who underwent ileocolic resection between 1997 and 2006 were analyzed. The mean follow-up time was 8.4 (±2.4) years.
  
  
  METHODS
  The cumulative probability for repeated intestinal resection for recurrent Crohn's disease was described by Kaplan-Meier curves. Predictors of surgical recurrence were analyzed by univariate tests.
  
  
  RESULTS
  One hundred five patients (51.7%) were exposed to azathioprine/6-mercaptopurine, and 28 patients (13.8%) were exposed to tumor necrosis factor-α blockers after operation. During the follow-up period, 32 patients (15.8%) were reoperated on for disease recurrence. At 5 and 10 years after index surgery, 95.5% and 81.3% of the patients had reoperation-free survival. Previous resections for Crohn's disease (HR, 2.981; 95% CI, 1.411-6.29; p = 0.003) and urgent indication for surgery (HR, 2.729; 95% CI, 1.047-7.116; p = 0.03) were significant risk factors for reoperation. In addition, patients with postoperative complications following ileocolonic resection were more likely to require reoperation (HR, 1.712; 95% CI, 041-2.817; p = 0.03). In a multiple Cox regression model, previous intestinal resection for Crohn's disease remained significant (p = 0.0114) with a HR of 2.654 (95% CI, 1.246-5.654).
  
  
  CONCLUSIONS
  The limitation is the retrospective design of the study, with its potential selection bias.
  
  
  CONCLUSIONS
  In the present analysis, previous intestinal resection for Crohn's disease was found to be an independent risk factor for surgical recurrence. Consequently, shorter surveillance intervals in this group of patients should be considered.
authors.affiliation: Department of General Surgery, Medical University of Vienna, Vienna, Austria. stefan.riss@meduniwien.ac.at
authors.forename: Stefan
authors.initials: S
authors.lastname: Riss
authors.forename: Isabelle
authors.initials: I
authors.lastname: Schuster
authors.forename: Pavol
authors.initials: P
authors.lastname: Papay
authors.forename: Martina
authors.initials: M
authors.lastname: Mittlböck
authors.forename: Anton
authors.initials: A
authors.lastname: Stift
mesh_terms: D001317:Austria / Q000453:epidemiology; D003082:Colectomy; D003106:Colon / Q000601:surgery*; D003424:Crohn Disease / Q000453:epidemiology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000601:surgery*; D015994:Incidence; D016016:Proportional Hazards Models; D012008:Recurrence; D012086:Reoperation / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors