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Risk factors associated with postoperative recurrence and repeat surgery in Japanese patients with Crohn’s disease

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

To avoid frequent surgery in patients with Crohn’s disease, it is important to identify the risk factors for postoperative recurrence or repeat surgery. However, there have so far been few studies on this topic from Asian countries. In addition, the recent development of anti-tumor necrosis factor (TNF) therapy may have changed the risk factors. We aimed to identify the factors associated with postoperative recurrence and repeat surgery.

Methods

The postoperative courses of 168 patients were reviewed. We analyzed the cumulative postoperative recurrence and repeat surgery rates and identified the factors affecting these rates.

Results

Postoperative recurrence was observed in 70 patients, and the 1-, 3-, and 5-year cumulative recurrence rates were 17.1, 40.1, and 54.9%, respectively. The recurrence rate was significantly higher in patients with anal lesions and lower in patients newly treated with anti-TNF agents following surgery. In a multivariate analysis, the new introduction of anti-TNF agents was identified as an independent suppressor (hazard ratio 0.50, 95% confidence interval 0.28–0.88). Twenty-four patients underwent repeat surgery, and the 1-, 3-, and 5-year cumulative repeat surgery rates were 4.6, 11.2, and 18.7%, respectively. The surgery rate was significantly higher in patients with penetrating-type disease. In a multivariate analysis, penetrating-type disease (6.98, 2.37–23.35), anal lesions (4.40, 1.14–30.53), and first-time surgery (5.28, 1.17–17.93) were identified as independent risk factors.

Conclusions

Anti-TNF agents have the potential to prevent postoperative recurrence. The new introduction, dose escalation, or switching of anti-TNF agents is recommended in patients with some risk factors.

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Author notes

  1. Jun Kusaka and Hisashi Shiga contributed equally to this manuscript.

Authors and Affiliations

  1. Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan

    Jun Kusaka, Masatake Kuroha, Tomoya Kimura, Yoichi Kakuta, Katsuya Endo, Yoshitaka Kinouchi & Tooru Shimosegawa

  2. Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine, Akita, Japan

    Hisashi Shiga

Authors
  1. Jun Kusaka
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  2. Hisashi Shiga
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  3. Masatake Kuroha
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  4. Tomoya Kimura
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  5. Yoichi Kakuta
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  6. Katsuya Endo
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  7. Yoshitaka Kinouchi
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  8. Tooru Shimosegawa
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Corresponding author

Correspondence to Hisashi Shiga.

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The authors declare that they have no conflict of interest.

Ethical approval

The institutional ethics committee approved the present study.

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Kusaka, J., Shiga, H., Kuroha, M. et al. Risk factors associated with postoperative recurrence and repeat surgery in Japanese patients with Crohn’s disease. Int J Colorectal Dis 32, 1407–1413 (2017). https://doi.org/10.1007/s00384-017-2867-8

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  • DOI: https://doi.org/10.1007/s00384-017-2867-8

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