Immediate prophylactic <i>vs</i> endoscopic or symptomatic‐driven azathioprine treatment to prevent surgical recurrence after intestinal resection for Crohn's disease

Guo, Zhen; Cai, Xiwen; Liu, R.; Gong, Jianfeng; Li, Y.; Cao, Lei; Wang, Zihao; Zhu, Weiming

doi:10.1111/codi.14352

Cited by 8 publications

(6 citation statements)

References 25 publications

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“…Another study using an identical definition of symptomatic anastomotic recurrence to ours reported very similar findings, namely that age was associated with clinical recurrence using univariate analysis with a trend towards earlier clinical recurrence in their multivariate model [18]. In another retrospective study, age at diagnosis <17 years was the only independent risk factor for surgical recurrence using multivariate analysis [19]. Other studies have failed to show an association between age at the time of Crohn's disease diagnosis and POR [20–26].…”

Section: Discussionsupporting

confidence: 67%

Risk factors for symptomatic anastomotic postoperative recurrence following ileo‐colic resection in Crohn’s disease

et al. 2021

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Aim Crohn's disease is a chronic inflammatory bowel disease characterized by alternating periods of exacerbation and remission. Surgical resection is not curative and postoperative recurrence (POR) remains a challenge in these patients. The aim of this study was to identify clinical variables that influence the risk of symptomatic anastomotic POR in patients with ileo‐colonic Crohn's disease. Method A retrospective study of Crohn's disease patients who had undergone ileo‐colic resection between January 2014 and December 2018 was performed. For each patient, data including demographic information, Crohn's disease clinical setting, preoperative radiological data, operative and histological data, pre‐ and postoperative medication history and postoperative clinical course, including recurrence of disease, were extracted. Symptomatic anastomotic POR was defined as symptoms of Crohn's disease in the presence of confirmed anastomotic POR (endoscopic and/or radiological POR). Results For the study period, 104 patients were eligible and included for analysis. The cumulative probability of symptomatic anastomotic POR was 14%, 30%, 42%, 50% and 50% at 1, 2, 3, 4 and 5 years, respectively. Two clinical variables on multivariate analysis were associated with increased risk of symptomatic anastomotic POR, namely age <17 years at diagnosis [hazard ratio (HR) 2.17, p = 0.019] and gastrointestinal involvement (extent) >30 cm (HR 1.85, p = 0.048). Conclusion This study describes the natural history of POR after ileo‐colic resection for Crohn's disease, as defined by endoscopic, radiological and clinical outcomes. Age <17 years at diagnosis and gastrointestinal involvement (extent) >30 cm were independent risk factors for symptomatic anastomotic POR.

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Section: Discussionsupporting

confidence: 67%

Risk factors for symptomatic anastomotic postoperative recurrence following ileo‐colic resection in Crohn’s disease

et al. 2021

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“… 35 , 36 According to recent studies, azathioprine use after the detection of endoscopic recurrence was not inferior to immediate azathioprine use after surgery in terms of clinical outcomes. 37 , 38 Besides biologic agents, further studies are needed to determine the role of immunomodulators in POR.…”

Section: Discussionmentioning

confidence: 99%

Continued Postoperative Use of Tumor Necrosis Factor-α Inhibitors for the Prevention of Crohn’s Disease Recurrence

Hyun

Park

et al. 2022

Gut and Liver

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Background/Aims: Many patients with Crohn's disease (CD) undergo intestinal resection during the disease course. Despite surgery, postoperative recurrence (POR) commonly occurs. Although postoperative use of tumor necrosis factor α (TNF-α) inhibitors is known to be effective in preventing POR, few studies have evaluated the effectiveness of continuing the same TNF-α inhibitors postoperatively in patients who received TNF-ɑ inhibitors before surgery.Methods: This retrospective observational study was performed in a single tertiary medical center. We retrospectively reviewed patients who had undergone the first intestinal resection due to CD and divided them into two groups: TNF-α inhibitor users in both the preoperative and postoperative periods, and TNF-α inhibitor users in only the preoperative period. We compared the clinical outcomes between these two groups.Results: In total, 45 patients who used TNF-α inhibitors preoperatively were recruited. Among them, TNF-α inhibitors were used postoperatively in 20 patients (44.4%). The baseline characteristics except age at diagnosis were similar in both groups. The rates of surgical and endoscopic recurrence were not different between the two groups, but the cumulative clinical recurrence rate was significantly lower in the postoperative TNF-α inhibitors group (log-rank p=0.003). In multivariate Cox regression analysis, postoperative TNF-α inhibitors use was significantly associated with a decreased risk of clinical recurrence (adjusted hazard ratio, 0.204; 95% confidence interval, 0.060 to 0.691; p=0.011). Conclusions:Continuing TNF-α inhibitors postoperatively in patients who were receiving TNF-α inhibitors before surgery significantly reduced the rate of clinical recurrence. For patients with CD who received TNF-α inhibitors preoperatively, continuing their use after surgery could be recommended.

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“…At present, there is no consensus concerning the optimal strategy. Whilst there is now a trend for colonoscopic findings at 6–12 months to determine the need for postoperative medical prophylaxis, some clinicians prefer to start this immediately postoperatively to increase the ‘disease‐free window’ .…”

Section: Discussionmentioning

confidence: 99%

Temporary faecal diversion in ileocolic resection for Crohn’s disease: is there an impact on long‐term surgical recurrence?

et al. 2019

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Aim Temporary faecal diversion after ileocolic resection (ICR) for Crohn’s disease reduces postoperative anastomotic complications in high‐risk patients. The aim of this study was to assess if this approach also reduces long‐term surgical recurrence. Method This was a multicentre retrospective review of prospectively maintained databases. Patient demographics, medical and surgical details were collected by three specialist centres. All patients had undergone an ICR between 2000 and 2012. The primary end‐point was surgical recurrence. Results Three hundred and twelve patients (80%) underwent an ICR without covering ileostomy (one stage). Seventy‐seven (20%) had undergone an ICR with end ileostomy/double‐barrel ileostomy/enterocolostomy followed by closure (two stage). The median follow‐up was 105 months [interquartile range (IQR) 76–136 months]. The median time to ileostomy closure was 9 months (IQR 5–12 months). There was no significant difference in surgical recurrence between the one‐ and two‐stage groups (18% vs 16%, P = 0.94). We noted that smokers (20% vs 34%, P = 0.01) and patients with penetrating disease (28% vs 52%, P < 0.01) were more likely to be defunctioned. A reduced recurrence rate was observed in the small high‐risk group of patients who were smokers with penetrating disease behaviour treated with a two‐stage strategy (0/10 vs 4/7, P = 0.12). Conclusion Despite having higher baseline risk factors, the results in terms of rate of surgical recurrence over 9 years are similar for patients having a two‐stage compared with a one‐stage procedure.

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Immediate prophylactic vs endoscopic or symptomatic‐driven azathioprine treatment to prevent surgical recurrence after intestinal resection for Crohn's disease

Cited by 8 publications

References 25 publications

Risk factors for symptomatic anastomotic postoperative recurrence following ileo‐colic resection in Crohn’s disease

Risk factors for symptomatic anastomotic postoperative recurrence following ileo‐colic resection in Crohn’s disease

Continued Postoperative Use of Tumor Necrosis Factor-α Inhibitors for the Prevention of Crohn’s Disease Recurrence

Temporary faecal diversion in ileocolic resection for Crohn’s disease: is there an impact on long‐term surgical recurrence?

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