Risk factors associated with postoperative recurrence and repeat surgery in Japanese patients with Crohn’s disease

Kusaka, Jun; Shiga, Hisashi; Kuroha, Masatake; Kimura, Tsutomu; Kakuta, Yoichi; Endo, Katsuya; Kinouchi, Yoshitaka; Shimosegawa, Tooru

doi:10.1007/s00384-017-2867-8

Cited by 11 publications

(14 citation statements)

References 25 publications

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“…The existing data supported that smoking history 27,28 , penetrating lesions 27,29 , postoperative perianal lesions 28,29 and emergency surgery 28 were risk factors for postoperative recurrence, whereas azathioprine 27 , antitumor necrosis factor 29 and mesenteric resection 30 were protective factors. Due to the long-term use of glucocorticoids, immunosuppressive agents and malnutrition in patients required surgical treatment, one-stage temporary ostomy to improve nutritional status, as well as two-stage ostomy and intestinal anastomosis were common modes of operation under these circumstances.…”

Section: Discussionmentioning

confidence: 77%

No Association between staging operation and the 5-Year Risk of Reoperation in Patients with Crohn’s Disease

Zhou

Gong

et al. 2019

Sci Rep

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The aim of this study was to investigate the impact of staging operation on the risk of reoperation in patients with CD who underwent primary bowel resection. This was a retrospective study of 980 patients with CD who were hospitalized in Jinling Hospital Affiliated to Nanjing Medical University between January 1, 2001, and October 1, 2016. The patients were grouped according to staging operation (n = 64) and one-stage operation (n = 148). Postoperative intestinal function recovery time, postoperative short-term complications, and reoperation rates were compared between the two groups. There was significant difference in disease behavior between the staging operation group and the one-stage operation group. There was no significant difference in postoperative tolerance of enteral nutrition among groups (P > 0.05). Obvious differences were found in the comparison of the first time of exhaustion, defecation after operation, postoperative length of stay and postoperative complications among groups (all P < 0.05). There was no difference in the 5-year cumulative reoperation-free rates between the two groups (P > 0.05). In conclusion, surgical intervention at proper time and appropriate operation during operation are essential for patients with CD. It is believed that staging operation with ostomy followed by intestinal anastomosis is feasible when there are more than two risk factors for postoperative intra-abdominal infectious complications.

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Section: Discussionmentioning

confidence: 77%

No Association between staging operation and the 5-Year Risk of Reoperation in Patients with Crohn’s Disease

Zhou

Gong

et al. 2019

Sci Rep

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“…2 Recently, several studies conducted in Asia showed contrary results from the present study. 11,32 During our follow-up periods, the use of anti-TNF agents, both infliximab and adalimumab, were covered by national insurance whenever fulfilling following criteria of unresponsive effect with more than 2 drugs or moderate CD with contraindication to corticosteroid or immunomodulator. Therefore, a considerable number of patients could use anti-TNF medications after marked endoscopic and clinical recurrence.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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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 le-sions were independent risk factors for surgical recurrence. Postoperative thiopurine treatment significantly reduced the incidence of surgical recurrence.

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“…A previous study found that ≥ 900 kcal per day was effective for preventing endoscopic and clinical CD recurrence [14]. In another study, 600 kcal/day was used as the cutoff [15]. Based on our results, we recommend 1200 kcal/ day to minimize the risk of CD recurrence and reoperation.…”

Section: Discussionmentioning

confidence: 63%

Elemental diet therapy plays a significant role in preventing surgical recurrence of Crohn’s disease in the era of biologics

Shinozaki

Yokoyama²,

Saigusa³

et al. 2020

Surg Today

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Purpose Most patients with Crohn's disease (CD) experience surgical recurrence. In this era of novel therapies, we conducted this study to clarify which treatments effectively decrease the risk of surgical recurrence in patients with CD. Methods The subjects of this retrospective study were 37 patients with CD. We created cumulative surgery rate curves and performed univariate and multivariate analyses. Results Univariate analysis revealed that patients who consumed an elemental diet (ED; ≥ 900 kcal/day), anti-tumor necrosis factor-alpha, and thiopurines had a significantly better prognosis than those who did not (p = 0.011, p = 0.025, and p = 0.0080, respectively). Multivariate analysis revealed that ED therapy and thiopurines were independent significant factors for controlling surgical recurrence (p = 0.046 and p = 0.032, respectively). Additional analyses showed that the most promising ED therapeutic dose was ≥ 1200 kcal/day, while an ED therapeutic dose of ≥ 900 kcal/day was acceptable. Conclusions Although univariate analyses revealed that all three treatment strategies had significant effects on surgical recurrence in patients with CD, multivariate analysis revealed that only ED therapy was significantly associated with surgical recurrence rates. Thus, ED therapy plays an important role in the management of CD, even in the era of biological therapies.

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Risk factors associated with postoperative recurrence and repeat surgery in Japanese patients with Crohn’s disease

Abstract: Anti-TNF agents have the potential to prevent postoperative recurrence. The new introduction, dose escalation, or switching of anti-TNF agents is recommended in patients with some risk factors.

Cited by 11 publications

References 25 publications

No Association between staging operation and the 5-Year Risk of Reoperation in Patients with Crohn’s Disease

No Association between staging operation and the 5-Year Risk of Reoperation in Patients with Crohn’s Disease

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

Elemental diet therapy plays a significant role in preventing surgical recurrence of Crohn’s disease in the era of biologics

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