Risk factors for post-operative recurrence in Korean patients with Crohn's disease

Abstract

Despite the advances in medical treatments, a considerable number of patients with Crohn’s disease (CD) ultimately need surgery. However, postoperative recurrence is common and factors that predict postoperative recurrence are still unclear, especially in East Asian countries. We investigated postoperative outcomes and identified the risk factors associated with postoperative recurrence after intestinal resective surgery in patients with CD. We retrospectively reviewed 173 CD patients who underwent intestinal resection due to CD between January 2005 and August 2014. Clinical recurrence was defined as occurrence of CD-related symptoms with any of the followings: medication step up, requiring systemic corticosteroid use, or CD activity index over 150 points. Forty-three (24.9%) patients received a follow-up colonoscopy within 1 year after surgery and endoscopic recurrence was 65.1%. Six year-cumulative clinical recurrence and surgical recurrence rate were 91.1% and 48.0%, respectively. In univariate analysis, young age at diagnosis (<16 years), and perianal disease were associated with clinical recurrence. Multivariate analysis showed that early maintenance of thiopurine medication after surgery within 3 months (p=0.04) was independently associated with a lower clinical recurrence rate, whereas perianal disease (p=0.02) was associated with a higher clinical recurrence. Moreover, current smoking at surgery (p=0.02) was significantly related to higher surgical recurrence rate. Post-operative recurrence rate in Korean CD patients showed the similar outcome compared with that in Caucasians, despite considerably different disease phenotypes and managing strategies. More intensive management strategies will be required in patients with perianal disease, young age onset, and smoking history. Maintenance of immunomodulatory medications after bowel resection in high-risk patients with CD might be an effective preventive strategy for clinical recurrence.