TY - JOUR
T1 - Re-resection Rates and Disease Recurrence in Crohn's Disease - A Population-Based Study Using Individual-Level Patient Data
AU - Poulsen, Anja
AU - Rasmussen, Julie
AU - Wewer, Mads Damsgaard
AU - Holm Hansen, Esben
AU - Nordestgaard, Rie Louise Møller
AU - Søe Riis Jespersen, Hans
AU - Christiansen, Dagmar
AU - Surnacheva, Elena
AU - Lin, Viviane Annabelle
AU - Aydemir, Nurcan
AU - Verlo, Kari Anne
AU - Rønne Pachler, Frederik
AU - Ovesen, Pernille Dige
AU - Fuglsang, Kristian Asp
AU - Brandt, Christopher Filtenborg
AU - Sørensen, Lars Tue
AU - Krarup, Peter-Martin
AU - Gögenur, Ismail
AU - Burisch, Johan
AU - Seidelin, Jakob B
N1 - © The Author(s) 2024. Published by Oxford University Press on behalf of European Crohn’s and Colitis Organisation. All rights reserved. For commercial re-use, please contact [email protected] for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact [email protected].
PY - 2024/10/15
Y1 - 2024/10/15
N2 - 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.
AB - 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.
KW - Adult
KW - Crohn Disease/surgery
KW - Denmark/epidemiology
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Recurrence
KW - Reoperation/statistics & numerical data
KW - Retrospective Studies
KW - Risk Factors
UR - http://www.scopus.com/inward/record.url?scp=85206597804&partnerID=8YFLogxK
U2 - 10.1093/ecco-jcc/jjae070
DO - 10.1093/ecco-jcc/jjae070
M3 - Journal article
C2 - 38727089
SN - 1873-9946
VL - 18
SP - 1631
EP - 1643
JO - Journal of Crohn's & colitis
JF - Journal of Crohn's & colitis
IS - 10
ER -