Department of Colorectal Surgery, Barts Health NHS Trust, The Royal London Hospital, London, UK.
Department of Radiology, Barts Health NHS Trust, The Royal London Hospital, London, UK.
Colorectal Dis. 2021 May;23(5):1184-1192. doi: 10.1111/codi.15530. Epub 2021 Feb 3.
Crohn's disease is a chronic inflammatory bowel disease characterized by alternating periods of exacerbation and remission. Surgical resection is not curative and postoperative recurrence (POR) remains a challenge in these patients. The aim of this study was to identify clinical variables that influence the risk of symptomatic anastomotic POR in patients with ileo-colonic Crohn's disease.
A retrospective study of Crohn's disease patients who had undergone ileo-colic resection between January 2014 and December 2018 was performed. For each patient, data including demographic information, Crohn's disease clinical setting, preoperative radiological data, operative and histological data, pre- and postoperative medication history and postoperative clinical course, including recurrence of disease, were extracted. Symptomatic anastomotic POR was defined as symptoms of Crohn's disease in the presence of confirmed anastomotic POR (endoscopic and/or radiological POR).
For the study period, 104 patients were eligible and included for analysis. The cumulative probability of symptomatic anastomotic POR was 14%, 30%, 42%, 50% and 50% at 1, 2, 3, 4 and 5 years, respectively. Two clinical variables on multivariate analysis were associated with increased risk of symptomatic anastomotic POR, namely age <17 years at diagnosis [hazard ratio (HR) 2.17, p = 0.019] and gastrointestinal involvement (extent) >30 cm (HR 1.85, p = 0.048).
This study describes the natural history of POR after ileo-colic resection for Crohn's disease, as defined by endoscopic, radiological and clinical outcomes. Age <17 years at diagnosis and gastrointestinal involvement (extent) >30 cm were independent risk factors for symptomatic anastomotic POR.
克罗恩病是一种慢性炎症性肠病，其特征是缓解期和加重期交替出现。手术切除不是根治性的，这些患者术后复发（POR）仍然是一个挑战。本研究旨在确定影响克罗恩病患者回肠结肠切除术吻合口症状性 POR 风险的临床变量。
对 2014 年 1 月至 2018 年 12 月期间接受回肠结肠切除术的克罗恩病患者进行回顾性研究。对每位患者，提取包括人口统计学信息、克罗恩病临床背景、术前影像学数据、手术和组织学数据、术前和术后用药史以及术后临床病程（包括疾病复发）在内的数据。吻合口症状性 POR 定义为存在确诊的吻合口 POR（内镜和/或放射学 POR）时的克罗恩病症状。
在研究期间，有 104 名患者符合条件并纳入分析。1、2、3、4 和 5 年时吻合口症状性 POR 的累积概率分别为 14%、30%、42%、50%和 50%。多变量分析中有两个临床变量与吻合口症状性 POR 的风险增加相关，即诊断时年龄<17 岁（风险比[HR]2.17，p=0.019）和胃肠道受累（范围）>30cm（HR 1.85，p=0.048）。
本研究描述了克罗恩病回肠结肠切除术后 POR 的自然史，定义为内镜、放射学和临床结果。诊断时年龄<17 岁和胃肠道受累（范围）>30cm 是吻合口症状性 POR 的独立危险因素。
