Re-resection Rates and Disease Recurrence in Crohn's Disease - A Population-Based Study Using Individual-Level Patient Data

Anja Poulsen*, Julie Rasmussen, Mads Damsgaard Wewer, Esben Holm Hansen, Rie Louise Møller Nordestgaard, Hans Søe Riis Jespersen, Dagmar Christiansen, Elena Surnacheva, Viviane Annabelle Lin, Nurcan Aydemir, Kari Anne Verlo, Frederik Rønne Pachler, Pernille Dige Ovesen, Kristian Asp Fuglsang, Christopher Filtenborg Brandt, Lars Tue Sørensen, Peter-Martin Krarup, Ismail Gögenur, Johan Burisch, Jakob B Seidelin

*Corresponding author for this work

Abstract

BACKGROUND AND AIMS: Despite advances in the medical treatment of Crohn's disease [CD], many patients will still need bowel resections and face the subsequent risk of recurrence and re-resection. We describe contemporary re-resection rates and identify disease-modifying factors and risk factors for re-resection.

METHODS: We conducted a retrospective, population-based, individual patient-level data cohort study covering 47.4% of the Danish population, including all CD patients who underwent a primary resection between 2010 and 2020.

RESULTS: Among 631 primary resected patients, 24.5% underwent a second resection, and 5.3% a third. Re-resection rates after 1, 5, and 10 years were 12.6%, 22.4%, and 32.2%, respectively. Reasons for additional resections were mainly disease activity [57%] and stoma reversal [40%]. Disease activity-driven re-resection rates after 1, 5, and 10 years were 3.6%, 10.1%, and 14.1%, respectively. Most stoma reversals occurred within 1 year [80%]. The median time to recurrence was 11.0 months. Biologics started within 1 year of the first resection revealed protective effect against re-resection for stenotic and penetrating phenotypes. Prophylactic biologic therapy at primary ileocaecal resection reduced disease recurrence and re-resection risk (hazard ratio [HR] 0.58, 95% confidence interval [CI] [0.34-0.99], p = 0.047). Risk factors for re-resection were location of resected bowel segments at the primary resection, disease location, disease behaviour, smoking, and perianal disease.

CONCLUSION: Re-resection rates, categorised by disease activity, are lower than those reported in other studies and are closely associated with disease phenotype and localisation. Biologic therapy may be disease-modifying for certain subgroups when initiated within 1 year of resection.

Original languageEnglish
JournalJournal of Crohn's & colitis
Volume18
Issue number10
Pages (from-to)1631-1643
Number of pages13
ISSN1873-9946
DOIs
Publication statusPublished - 15 Oct 2024

Keywords

  • Adult
  • Crohn Disease/surgery
  • Denmark/epidemiology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Recurrence
  • Reoperation/statistics & numerical data
  • Retrospective Studies
  • Risk Factors

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