title: Complications and Disease Recurrence After Primary Ileocecal Resection in Pediatric Crohn's Disease: A Multicenter Cohort Analysis.
abstract: Studies on the outcome of ileocecal resection in pediatric Crohn's disease (CD) have a limited follow-up and fail to assign predictors of adverse outcomes. Therefore, we aimed to investigate (I) the complication and disease recurrence rates and (II) identify risk factors for these adverse outcomes after ileocecal resection for pediatric CD.
  
  
  
  This is a retrospective cohort analysis of all children (<18 years) that underwent ileocecal resection as first intestinal resection for CD derived from 7 tertiary hospitals in the Netherlands (1990-2015). Risk factors were identified using multivariable analysis.
  
  
  
  In total, 122 children were included (52% male; median age 15.5 years [interquartile range 14.0-16.0]). Severe postoperative complications rate was 10%. Colonic disease (odds ratio: 5.6 [95% confidence interval {CI}: 1.3-26.3], P = 0.024), microscopically positive resection margins (odds ratio: 10.4 [95% CI: 1.1-100.8] P = 0.043), and emergency surgery (odds ratio: 6.8 [95% CI: 1.1-42.2], P = 0.038) were risk factors for severe complications. Clinical and surgical recurrence rates after 1, 5 and 10 years were 19%, 49%, 71% and 2%, 12%, 22%, respectively. Female sex (hazard ratio [HR]: 2.1 [95% CI: 1.1-3.8], P = 0.023) was a risk factor for clinical recurrence, whereas ileocecal disease (HR: 3.9 [95% CI: 1.2-12.5], P = 0.024) and microscopically positive resection margins (HR: 9.6 [95% CI: 1.2-74.5], P = 0.031) were risk factors for surgical recurrence. Immediate postoperative therapy reduced the risk of both clinical (HR: 0.3 [95% CI: 0.1-0.6], P = 0.001) and surgical (HR: 0.5 [95% CI: 0.1-0.9], P = 0.035) recurrence.
  
  
  
  Ileocecal resection is an effective and durable treatment of pediatric CD, although postoperative complications occur frequently. Postoperative therapy may be started immediately to prevent disease recurrence.
authors.affiliation: *Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands; †Department of Pediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands; ‡Department of Pediatric Gastroenterology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands; §Department of Pediatric Gastroenterology, University Medical Center Utrecht, Utrecht, the Netherlands; ‖Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands; ¶Department of Pediatric Gastroenterology, Radboud University Medical Center, Nijmegen, the Netherlands; **Department of Pediatric Gastroenterology, VU University Medical Center, Amsterdam, the Netherlands; ††Department of Pediatrics, Amphia Hospital, Breda, the Netherlands; ‡‡Department of Pediatric Surgery, Academic Medical Center, Amsterdam, the Netherlands; and §§Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands.
authors.forename: Kay
authors.initials: K
authors.lastname: Diederen
authors.forename: Lissy
authors.initials: L
authors.lastname: de Ridder
authors.forename: Patrick
authors.initials: P
authors.lastname: van Rheenen
authors.forename: Victorien M
authors.initials: VM
authors.lastname: Wolters
authors.forename: Maria L
authors.initials: ML
authors.lastname: Mearin
authors.forename: Gerard M
authors.initials: GM
authors.lastname: Damen
authors.forename: Tim G
authors.initials: TG
authors.lastname: de Meij
authors.forename: Herbert
authors.initials: H
authors.lastname: van Wering
authors.forename: Laura A
authors.initials: LA
authors.lastname: Tseng
authors.forename: Matthijs W
authors.initials: MW
authors.lastname: Oomen
authors.forename: Justin R
authors.initials: JR
authors.lastname: de Jong
authors.forename: Cornelius E
authors.initials: CE
authors.lastname: Sloots
authors.forename: Marc A
authors.initials: MA
authors.lastname: Benninga
authors.forename: Angelika
authors.initials: A
authors.lastname: Kindermann
mesh_terms: D000293:Adolescent; D002432:Cecum / Q000601:surgery*; D003424:Crohn Disease / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery*; D008297:Male; D009426:Netherlands; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011184:Postoperative Period; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome