Abstract
PURPOSE: This study was undertaken to investigate the factors that influenced the risk of symptomatic recurrence in patients with Crohn's disease who were treated with primary resective surgery. METHODS: Data regarding age, gender, time from diagnosis to surgery, medication, preoperative infectious complications, laboratory values, emergency/elective surgery, location and extent of disease, and resection margins were analyzed in relation to recurrence in 353 patients who were undergoing a “curative” resection in 1969 to 1986. RESULTS: Univariate analyses showed a higher risk of recurrence in women with ileal and ileocolonic disease than in men ( P <0.05), in patients with ileocolonic disease compared with those with isolated ileal disease ( P <0.05), and in ileal disease patients with an increased disease extent ( P <0.05). In a multivariate analysis performed on patients with ileal disease, increased disease extent, limited resection on the colonic side, and referral from other hospitals were three independent variables that indicated an increased risk of recurrence ( P < 0.05). Length of disease-free resection margins did not influence the risk of recurrence either in univariate or in multivariate analysis ( P >0.05). CONCLUSIONS: Disease extent has prognostic value regarding the risk of symptomatic recurrence in Crohn's disease, whereas the length of resection margins does not influence the risk of relapse. These results favor a conservative approach, particularly in patients with extensive disease.
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Lindhagen T, Ekelund G, Leandoer J, Hildell J, Lindström C, Wenckert A. Pre- and post-operative complications in Crohn's disease with special reference to duration of preoperative disease history. Scand J Gastroenterol 1984;19:194–203.
Wolff BG, Beart RW Jr, Frydenberg HB, Weiland LH, Agrez MV, Ilstrup DM. The importance of disease-free margins in resections for Crohn's disease. Dis Colon Rectum 1983;26:239–43.
Pennington L, Hamilton SR, Bayless TM, Cameron JL. Surgical management of Crohn's disease: influence of disease at margin of resection. Ann Surg 1980;192:311–8.
Lee EC, Papaionnou N. Minimal surgery for chronic obstruction in patients with extensive or universal Crohn's disease. Ann R Coll Surg Engl 1982;64:229–33.
Sayfan J, Wilson DA, Allan A, Andrews H, Alexander-Williams J. Recurrence after strictureplasty or resection for Crohn's disease. Br J Surg 1989;76,335–8.
Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958;53:457–81.
Cox DR. Regression models and life tables (with discussion). J R Stat Soc B 1972;34:187–220.
Rutgeerts PR, Geboes K, Vantrappen G, Kerremans R, Coenegrachts JL, Coremans G. Natural history of recurrent Crohn's disease at the ileocolonic anastomosis after curative surgery. Gut 1984;25:665–72.
Olaison G, Smedh K, Sjödahl R. Natural course of Crohn's disease after ileocolic resection: endoscopically visualised ileal ulcers preceding symptoms. Gut 1992;33:331–5.
Lee EC, Papaioannou N. Recurrences following surgery for Crohn's disease. Clin Gastroenterol 1980;9:419–38.
Russell Lock M, Farmer RG, Fazio VW, Jagelman DG, Lavery IC, Weakley FL. Recurrence and reoperation for Crohn's disease: the role of disease location in prognosis. New Engl J Med 1981;304:1586–8.
Mekhjian HS, Switz DM, Watts HD, Deren JJ, Katon RM, Beman FM. National cooperative Crohn's disease study: factors determining recurrence of Crohn's disease after surgery. Gastroenterology 1979;77:907–13.
Krause U, Bergman L, Norlén BJ. Crohn's disease: a clinical study on 186 patients. Scand J Gastroenterol 1971;6:97–108.
Dehn TC, Kettlewell MG, Mortensen NJ, Lee EC, Jewell DP. Ten-year experience of strictureplasty for obstructive Crohn's disease. Br J Surg 1989;76:339–41.
Kotangi H, Kramer K, Fazio VW, Petras RE. Do microscopic abnormalities at the resection margins correlate with increased anastomotic recurrence in Crohn's disease? Retrospective analysis of 100 cases. Dis Colon Rectum 1991;34:909–16.
Heuman R, Boeryd B, Bolin T, Sjödahl R. The influence of disease at the margin of resection on the outcome of Crohn's disease. Br J Surg 1983;70:519–21.
Hellberg R, Hultén L, Rosengren C, åhren C. The recurrence rate after primary excisional surgery for Crohn's disease. Acta Chir Scand 1980;146:435–43.
Burman JH, Cooke WT, Alexander-Williams J. The fate of ileorectal anastomosis in Crohn's disease. Gut 1971;12:432–6.
De Dombal FT, Burton I, Goligher JC. Recurrence of Crohn's disease after primary excisional surgery. Gut 1971;12:519–27.
Chardavoyne R, Flint GW, Pollack S, Wise L. Factors affecting recurrence following resection for Crohn's disease. Dis Colon Rectum 1986;29:495–502.
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Raab, Y., Bergström, R., Ejerblad, S. et al. Factors influencing recurrence in Crohn's disease. Dis Colon Rectum 39, 918–925 (1996). https://doi.org/10.1007/BF02053992
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DOI: https://doi.org/10.1007/BF02053992