Low Rates of Surgical Recurrence Following Ileocolic Resections for Crohn’s Disease in the Biologic Era
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Ileocolic resections (ICRs) are the most common resections for Crohn's disease. Historical control groups have often been used for comparison when assessing postoperative recurrence, usually with temporal bias. This study aimed to (1) report contemporary rates of postoperative recurrence requiring repeat surgery (surgical recurrence at anastomosis [surgical recurrence at the ileocolic resection site (SR-ICR)] or surgical recurrence at any site) and the rates of endoscopic recurrence (ER) in the "biologic era"; and (2) determine risk factors for SR-ICR and ER. METHODS: A retrospective multicenter study involving 12 tertiary Australian centers was performed. Patients (of any age) who had undergone an ICR for Crohn's disease between 2007 and 2023 were included. Cox proportional hazards modeling was used to evaluate clinicopathological risk factors for SR-ICR and ER (defined as Rutgeerts grade ≥i2b). RESULTS: Overall, 875 patients were included (mean 38.7 ± 15.1 years, 51% female). Median follow-up was 63.9 months. Rates of SR-ICR were 4.5% (95% confidence interval [CI], 2.8%-6.1%) and 12.8% (95% CI, 8.8%-16.5%) at 5 and 10 years, respectively. Rates of surgical recurrence at any site were 5.6% (95% CI, 3.8%-7.5%) and 15.1% (95% CI, 11.0%-19.1%) at 5 and 10 years, respectively. Early (within 12 months) ER occurred in 24.7%. On multivariable analysis, smoking (adjusted hazard ratio, 3.49; 95% CI, 1.93-6.29) was the only factor significantly associated with SR-ICR. Smoking, positive microscopic margins, and granulomas were associated with ER, and prophylactic therapy and younger age at diagnosis (<17 years) were protective. CONCLUSIONS: The rate of SR at the ileocolic anastomosis in this large Australian cohort was low, recorded to be 1 in 20 at 5 years. Smoking remains the strongest risk factor for both ER and SR. Histopathological factors influence ER and should be considered in future risk prediction models.
Source: Inflammatory Bowel Diseases
DOI: 10.1093/ibd/izaf244
Authors: Hugh L Giddings, Kheng-Seong Ng, Michael J Solomon, Arteen Arzivian, Craig Haifer, Huiyu Lin, Christian Pappas, David Clark, Anthony Deacon, Graham Radford-Smith, Nargus Ebrahimi, Ann Wu, Mark Lewis, Roscoe Lim, Jennifer Zhang, Abhinav Vasudevan, Kathryn Demase, Jadon Karp, Richard G Fernandes, Yoon-Kyo An, Zi Qin Ng, Scott Mackenzie, Lena Thin, Tessa Greeve, Gregory T Moore, Susan J Connor, Jane M Andrews, Miles P Sparrow, Simon Ghaly
Institutions: The University of Sydney, Royal Prince Alfred Hospital, Concord Repatriation General Hospital, St Vincent's Hospital Sydney, UNSW Sydney, Tan Tock Seng Hospital, St Vincent’s Private Hospital Brisbane, The University of Queensland, Royal Brisbane and Women's Hospital, Royal Adelaide Hospital, Eastern Health, Monash University, The Alfred Hospital, Alfred Health, Mater Research, Mater Adult Hospital, Liverpool Hospital, Fiona Stanley Hospital, Monash Health, The University of Adelaide
Language: English
Topic: Inflammatory Bowel Disease
Subfield: Genetics
Domain: Life Sciences
Open Access status: hybrid
Estimated APC paid: $3,862
Funder: University of Sydney
OpenAlex ID: W4416987048