Predictive Factors of Surgical Recurrence in Patients with Crohn's Disease on Long-Term Follow-Up: A Focus on Histology

Abstract

In patients with Crohn’s disease (CD) that underwent surgery, predictive factors of surgical recurrence have been only partially identified. The aim of our study was to identify potential factors associated with an increased risk of surgical recurrence. A monocentric retrospective observational study was conducted including patients diagnosed with CD, according to ECCO criteria who received their first ileocolic resection. Overall, 162 patients were enrolled in our study; 54 of them were excluded due to a lack of sufficient data. The median follow-up was 136.5 months, IQR 91.5−176.5, and the surgical recurrence rate after the median follow-up was 21.3%. In the multivariate analysis, an age ≤ 28 years at the first surgical resection (aHR = 16.44, p < 0.001), current smoking (aHR = 15.84, p < 0.001), female sex (aHR = 7.58, p < 0.001), presence of granulomas at local lymph nodes (aHR = 12.19, p < 0.001), and treatment with systemic corticosteroids after the first surgical resection (aHR = 7.52, p = 0.002) were factors significantly associated with a risk of surgical recurrence, while cryptitis resulted in a protective factor (aHR = 0.02, p < 0.001). In conclusion, the heterogeneous spectrum of factors associated to the risk of surgical recurrence in patients with CD that underwent ileocolic resection supports the need of a personalized follow-up taking into account different clinical, surgical, and histologic features.

Keywords: IBD; cryptitis; granulomas; inflammatory bowel diseases.

Figure 1

Cumulative surgical recurrence rates calculated using the Kaplan–Meier method.

Figure 2

Cumulative surgical recurrence rates calculated using the Kaplan–Meier method. At the median FU of 136.5 months, the 82.2% of patients with age > 27 years at CD diagnosis was surgical recurrence-free, compared to the 75.5% of patients with age ≤ 27 years at CD diagnosis (A), the 84.6% of patients with age > 28 years at first surgery was surgical recurrence-free as compared to the 66.7% of patients with age ≤ 28 years at first surgery (B), the 90.1% of former/never smokers was surgical recurrence-free as compared to the 68.7% of current smokers (C), and the 92.7% of patients that did not receive systemic steroid therapy was surgical recurrence-free as compared to the 70.9% of patients administered with systemic steroid therapy (D).