Ann Coloproctol.  2015 Aug;31(4):144-152. 10.3393/ac.2015.31.4.144.

Long-term Outcomes and Risk Factors for Reoperation After Surgical Treatment for Gastrointestinal Crohn Disease According to Anti-tumor Necrosis Factor-alpha Antibody Use: 35 Years of Experience at a Single Institute in Korea

• Lee SM
• Han EC
• Ryoo SB
• Oh HK
• Choe EK
• Moon SH
• Kim JS
• Jung HC
• Park KJ

• KMID: 2169718
• DOI: http://doi.org/10.3393/ac.2015.31.4.144

Abstract

PURPOSE
Crohn disease is characterized by high rates of recurrence and reoperations. However, few studies have investigated long-term surgical outcomes in Asian populations. We investigated risk factors for reoperation, particularly those associated with anti-tumor necrosis factor-alpha (anti-TNF-alpha) antibody use, and long-term follow-up results.
METHODS
We reviewed the records of 148 patients (100 males and 48 females) who underwent surgery for gastrointestinal Crohn disease and retrospectively analyzed long-term outcomes and risk factors.
RESULTS
The mean age at diagnosis was 28.8 years. Thirty-eight patients (25.7%) received monoclonal antibody treatment before reoperation. A small bowel and colon resection was most commonly performed (83 patients, 56.1%). The median follow-up was 149 months, during which 47 patients underwent reoperation. The median interval between the primary and the secondary surgeries was 65 months, with accumulated reoperation rates of 16.5%, 31.8%, and 57.2% after 5, 10, and 15 years, respectively. Obstruction was the most common indication for reoperation (37 patients, 25.0%). In a multivariable analysis, age <17 years at diagnosis (A1) (odds ratio [OR], 2.20; P = 0.023), penetrating behavior (B3) (OR, 4.39; P < 0.001), and no azathioprine use (OR, 2.87; P = 0.003) were associated with reoperation. Anti-TNF-alpha antibody use did not affect the reoperation rate (P = 0.767).
CONCLUSION
We showed a high reoperation rate regardless of treatment with anti-TNF-alpha antibody, which indicates that recurrent surgery is still needed to cure patients with gastrointestinal Crohn diseases. Younger age at primary operation, penetrating behavior, and no azathioprine use were significant factors associated with reoperation for gastrointestinal Crohn disease.

Keyword

Crohn disease; Reoperation; Azathioprine; Infliximab

MeSH Terms

Asian Continental Ancestry Group
Azathioprine
Colon
Crohn Disease*
Diagnosis
Follow-Up Studies
Humans
Korea*
Male
Necrosis*
Recurrence
Reoperation*
Retrospective Studies
Risk Factors*
Infliximab
Azathioprine