Abstract
Aims
Concomitant lesions in the small intestine are common in Crohn’s disease (CD). This study aimed to detect the incidence of small bowel (SB) lesions in patients undergoing surgical resection for symptomatic ileocolic disease and whether concomitant SB lesions are associated with reoperation due to recurrent CD.
Methods
In this observational, historical cohort study, consecutive patients with CD undergoing primary ileocolic resection (ICR) from 2007 to 2019 were included. Clinical variables and intraoperative findings were extracted from a prospectively maintained database and analyzed by Cox proportional hazards regression models for identifying risk factors of reoperation.
Results
Of the 404 patients included, there were 202 (50%) patients having concomitant SB lesions, and 108 of them underwent concurrent surgical intervention for SB lesions whereas 94 did not. The presence of concomitant SB lesions was a risk factor for reoperation (p = 0.041). Subgroup analysis indicated that patients with concomitant uncomplicated SB lesions left in situ had a comparable rate of reoperation (p = 0.605) whereas patients having concomitant complicated SB lesions undergoing simultaneous surgical intervention showed a higher reoperation rate (P = 0.006) when compared with those without concomitant SB lesions. Interestingly, the adverse effects of concomitant SB lesions can be reversed in the setting of postoperative anti-TNF agents [HR 0.2; 95% CI (0.04–0.9); P=0.040].
Conclusions
Concomitant SB lesion(s), especially those complicated lesions, could be a risk factor for postoperative surgical recurrence in patients undergoing ICR. Active postoperative management strategies such as anti-TNF agents should be provided for these patients.
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Abbreviations
- Alb:
-
albumin
- anti-TNF:
-
anti-tumor necrosis factor
- AZA:
-
azathioprine
- CD:
-
Crohn’s disease
- CI:
-
confidence interval
- CRP:
-
C-reactive protein
- ESR:
-
erythrocyte sedimentation rate
- HR:
-
hazard ratio
- IBD:
-
inflammatory bowel disease
- ICR:
-
ileocolic resection
- IFX:
-
infliximab
- IQR:
-
interquartile range
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Acknowledgements
This work was partly supported by the National Natural Science Foundation of China (Grant 81670471, 81770556, and 81570500) and Jiangsu Provincial Medical Youth Talent (QNRC2016900, to Yi Li).
Funding
This work was partly supported by the National Natural Science Foundation of China (Grant 82170573, 81770556, and 81670471) and Jiangsu Provincial Medical Youth Talent (QNRC2016900, to Yi Li).
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Weiwen Qian, Lei Gao, and Liangyu Huang contributed equally to this work. Yi Li and Weiming Zhu conceived and designed the study, acquisition, and interpretation of data. Weiwen Qian, Lei Gao, and Liangyu Huang were involved in the interpretation of data and drafting of the manuscript; Zhen Guo and Lei Cao were involved in the analysis, acquisition, and interpretation of data; Jianfeng Gong was involved in the interpretation of data for the work, critical revision of the manuscript for important intellectual content.
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Figure S1.
The schematic diagram of surgery and residual lesions. (A) Ileocecal lesion (lesion I) led to penetration and obstruction. Lesion II and III were nonstricturing nonpenetrating diseases, which were macroscopically abnormal during operation. (B) Ileocecal lesion (lesion I) was resected and anastomosis was performed. Lesion II and III were retained as residual lesions. (PNG 1605 kb)
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Qian, W., Gao, L., Huang, L. et al. The Prevalence of Concomitant Skip Small Bowel Lesions in Crohn’s Disease and Their Effects on Reoperation in Patients Undergoing Ileocolic Resection. J Gastrointest Surg 26, 2330–2341 (2022). https://doi.org/10.1007/s11605-022-05436-4
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DOI: https://doi.org/10.1007/s11605-022-05436-4