Recurrence and impact of postoperative prophylaxis in laparoscopically treated primary ileocolic Crohn disease.

OBJECTIVES

To define risk factors for recurrence and to determine whether postoperative prophylaxis would influence time to recurrence after primary laparoscopic ileocolectomy for Crohn disease.

DESIGN

Retrospective record review.

SETTING

Tertiary academic medical center.

PATIENTS

All patients who underwent primary laparoscopic ileocolectomy for terminal ileal Crohn disease between April 28, 1994, and August 3, 2006, at the Mayo Clinic, Rochester, Minnesota.

MAIN OUTCOME MEASURES

All patients were reviewed for follow-up, recurrence, risk factors for recurrence, and use of postoperative immunosuppressive prophylaxis.

RESULTS

One hundred nine patients were identified, of whom 89 were followed up postoperatively at Mayo Clinic with a median follow-up of 3.5 years (range, 1.8 months to 11.9 years). Recurrence was discovered in 54 patients (61%) at a median of 13.1 months (range, 1.3 months to 8.7 years). Forty-four patients (49%) received postoperative immunosuppressive prophylaxis (37 [42%] received azathioprine, 8 [9%] received 6-mercaptopurine, and 3 [3%] received infliximab). In a multivariate model of various risk factors for recurrence, presence of granulomas was the only significant predictor of recurrence (P = .01). The 2-year cumulative recurrence rates in the prophylaxis and nonprophylaxis groups were 37.5% and 52.6%, respectively (log-rank test, P = .87).

CONCLUSIONS

Recurrence occurred in more than half of the patients with Crohn disease after primary laparoscopic ileocolectomy. In this highly selected patient population, use of immunosuppressive prophylaxis was not associated with a delay in recurrence. Presence of granulomas was the only significant predictor of recurrence. These findings should be further explored in larger and less selected patient populations.