1Servicio de Aparato Digestivo Hospital Universitari Germans Trias i Pujol and CIBERehd, Badalona, Spain; 2Unidad de Gestión Clínica de Aparato Digestivo, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, Spain; 3Servicio de Gastroenterologia, Hospital La Fe, Valencia, Spain; 4Servicio Medicina Digestiva Hospital General Universitario de Alicante y CIBEREHD Instituto de Salud Carlos III, Madrid, Spain; 5Servicio de Gastroenterología, Hospital Universitario Miguel Servet, Zaragoza, Spain; 6Servicio de Aparato Digestivo, Hospital Universitario La Paz, Madrid, Spain, IdiPaz; 7Servicio de Patología Digestiva Hospital de la Santa Creu y Sant Pau, Barcelona, Spain; 8Servicio de Gastroenterología, Hospital Puerta de Hierro, Madrid, Spain; 9Unidad de Gastroenterología Hospital Virgen Macarena, Sevilla, Spain; 10Servicio de Medicina Digestiva Hospital Clínico de Valencia, Universitat de Valencia; 11Servicio de Gastroenterología, Hospital Clínico San Carlos, Madrid, Spain; 12Departamento médico MSD, Madrid, Spain; and 13Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Aparato Digestivo Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain.
Inflamm Bowel Dis. 2017 Oct;23(10):1840-1846. doi: 10.1097/MIB.0000000000001180.
More than 50% of patients with Crohn's disease require intestinal resection at least once. Postoperative recurrence (POR) is almost uniform if prophylactic treatment is not started early. Endoscopic monitoring is generally advised. We studied the incidence and management of recurrence in patients who had undergone intestinal resection.
Practicrohn was an observational retrospective study performed in 26 Spanish hospitals including patients aged ≥18 years who underwent Crohn's disease-related ileocolonic resection between January 2007 and December 2010. We recorded preventive treatments, the incidence of clinical recurrence in daily practice, and associated risk factors.
The study population comprised 314 patients. Median (interquartile range) time from diagnosis to surgery was 6 (1-12) years. Prophylaxis for POR was administered to 208 patients (68%). Endoscopy was performed in 143 (46%) patients the first year after surgery. Clinical POR was detected in 97 patients (31%) after a median 315 (65-748) days. The cumulative probability of clinical POR was 16%, 27%, and 31% at 1, 3, and 5 years, respectively, being higher among patients not receiving immunomodulators as compared to those who received prophylaxis (P = 0.014). Forty-five patients (14%) required reoperation at 5 years after a median time from the first intervention of 228 (133-527) days.
In this real-life study, up to one-third of patients with Crohn's disease did not start preventive therapy after intestinal resection, and almost half of them were not endoscopically monitored as recommended. In this setting, 30% of patients developed clinical POR within the first 5 years after surgery, thus indicating that there is room for improvement.
超过 50%的克罗恩病患者至少需要进行一次肠道切除术。如果不早期开始预防性治疗，术后复发（POR）几乎是不可避免的。一般建议进行内镜监测。我们研究了接受肠道切除术的患者的复发发生率和处理方法。
Practicrohn 是一项在 26 家西班牙医院进行的观察性回顾性研究，纳入了 2007 年 1 月至 2010 年 12 月期间接受克罗恩病相关回肠结肠切除术的年龄≥18 岁的患者。我们记录了预防性治疗、日常实践中临床复发的发生率以及相关的危险因素。
研究人群包括 314 名患者。从诊断到手术的中位（四分位间距）时间为 6（1-12）年。208 名患者（68%）接受了 POR 的预防治疗。143 名患者（46%）在手术后的第一年进行了内镜检查。97 名患者（31%）在中位 315（65-748）天后出现了临床 POR。1、3 和 5 年时的临床 POR 累积概率分别为 16%、27%和 31%，未接受免疫调节剂治疗的患者比接受预防治疗的患者更高（P=0.014）。45 名患者（14%）在第一次干预后中位时间 228（133-527）天后需要再次手术。
在这项真实世界的研究中，多达三分之一的克罗恩病患者在肠道切除术后没有开始预防性治疗，而且几乎一半的患者没有按照建议进行内镜监测。在这种情况下，30%的患者在手术后 5 年内出现临床 POR，这表明仍有改进的空间。
