Gut Liver.  2020 May;14(3):331-337. 10.5009/gnl19085.

Risk Factors for Postoperative Recurrence in Korean Patients with Crohn’s Disease

Affiliations
  • 1Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
  • 2Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
  • 3Department of Internal Medicine, Ewha Womans University School of Medicine, Korea
  • 4Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Korea
  • 5Center for Crohn’s and Colitis, Department of Gastroenterology, Kyung Hee University College of Medicine, Korea
  • 6Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Korea
  • 7Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
  • 8Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Korea
  • 9Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Korea
  • 10Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea
  • 11Department of Public Health, Wonkwang University Graduate School, Iksan, Korea
  • 12Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
  • 13Department of Internal Medicine, Digestive Disease Research Institute, Wonkwang University College of Medicine, Iksan, Korea

Abstract

Background/Aims
A considerable number of patients with Crohn’s disease still need intestinal resection surgery. Postoperative recurrence is an important issue in Crohn’s disease management, including the selection of high-risk patients. Eastern Asian patients showed several differences from Caucasian patients. Therefore, we investigated the postoperative surgical recurrence outcome and identified risk factors in Korean patients.
Methods
Clinical data of 372 patients with Crohn’s disease who underwent first intestinal resection between January 2004 and August 2014 at 14 hospitals in Korea were retrospectively reviewed.
Results
Over the follow-up period, 50 patients (17.1%) showed surgical recurrence. The cumulative surgical recurrence rate was 6.5% at 1 year and 15.4% at 7 years. Age under 16 (p=0.011; hazard ratio [HR], 5.136; 95% confidence interval [CI], 1.576 to 16.731), colonic involvement (p=0.023; HR , 2.011; 95% CI, 1.102 to 3.670), and the presence of perianal disease at surgery (p=0.008; HR, 2.239; 95% CI, 1.236 to 4.059) were independent risk factors associated with surgical recurrence. Postoperative thiopurine treatment (p=0.002; HR, 0.393; 95% CI, 0.218 to 0.710) was a protective factor for surgical recurrence.
Conclusions
Among the disease characteristics at surgery, younger age, colonic location, and perianal lesions were independent risk factors for surgical recurrence. Postoperative thiopurine treatment significantly reduced the incidence of surgical recurrence.

Keyword

Crohn disease; Recurrence; Surgery; Risk factors; Thiopurine
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