OP016 Need for primary abdominal surgery, but not repeated surgery, has decreased: a nationwide study of temporal trends in Crohn surgery in Sweden 1990–2014

Rates of Postoperative Recurrence of Crohn’s Disease and Effects of Immunosuppressive and Biologic Therapies

“…A randomized trial from the International Organization for Study of Inflammatory Bowel Diseases in patients at higher risk of postoperative CD recurrence found no difference in terms of endoscopic remission at 2 years between systematic azathioprine therapy after surgery and initiation based on ileocolonoscopy findings at week 26 or 52 (18). Recent data from the Swedish nationwide cohort study showed that need for a second abdominal surgery in Crohn's disease has not decreased in the last 30 years (5). One explanation could be the treatment refractoriness of the CD postoperative setting.…”

“…Surgical rates have dropped since the 1960s due to improvement of medical therapy (3). However, in more recent cohorts, 1 out of 3 patients with CD still undergo an intestinal resection (4) and the need for a second surgery remains stable (5). The majority of patients experience endoscopic CD recurrence within the year following surgery, classically located at the anastomosis and/or in the neoterminal ileum (6).…”

The changing landscape of surgery for Crohn's disease

“…The studies included in the meta-analysis by Frolkis et al are however heterogeneous and a vast majority of the included patients were diagnosed prior to the introduction of IM and aTNF, with scarce or no information on type of surgical procedures. In a more recent study from Sweden the cumulative incidence for first abdominal surgery within ten years of CD diagnosis were as low as 21% for patients diagnosed between 2004 and 2009 and the cumulative incidence of a repeated abdominal procedure five years following the primary procedure was only 15% among those patients diagnosed with CD in 1996-2000 50 . A similar finding was presented by Jeuring et al from the Netherlands who found decreasing trends in need of hospitalization as well as use of surgery in CD while no change was seen in disease progression 51 .…”

“…Before the 1990's approximately half of all patients with colonic CD would have had surgery within 10 years of their diagnosis and a quarter will have had an ileostomy 85 . More recent numbers from Sweden show a 5-year risk of colonic segmental resection in all CD patients to be around 8% while the risk of colectomy or proctectomy is 1% and 0.6% respectively 50 . There seems to be similar risks of repeat surgery regardless of whether subtotal colectomy or segmental resection is performed, but with better quality of life and bowel function in the latter case 83 84 86 .…”