Caviglia Gian Paolo, Mineo Chiara Angela, Rosso Chiara, Armandi Angelo, Astegiano Marco, Canavese Gabriella, Resegotti Andrea, Saracco Giorgio Maria, Ribaldone Davide Giuseppe
Department of Medical Sciences, University of Turin, 10126 Turin, Italy.
Division of Gastroenterology, AOU Città della Salute e della Scienza-Molinette Hospital, 10126 Turin, Italy.
J Clin Med. 2022 Aug 27;11(17):5043. doi: 10.3390/jcm11175043.
In patients with Crohn’s disease (CD) that underwent surgery, predictive factors of surgical recurrence have been only partially identified. The aim of our study was to identify potential factors associated with an increased risk of surgical recurrence. A monocentric retrospective observational study was conducted including patients diagnosed with CD, according to ECCO criteria who received their first ileocolic resection. Overall, 162 patients were enrolled in our study; 54 of them were excluded due to a lack of sufficient data. The median follow-up was 136.5 months, IQR 91.5−176.5, and the surgical recurrence rate after the median follow-up was 21.3%. In the multivariate analysis, an age ≤ 28 years at the first surgical resection (aHR = 16.44, p < 0.001), current smoking (aHR = 15.84, p < 0.001), female sex (aHR = 7.58, p < 0.001), presence of granulomas at local lymph nodes (aHR = 12.19, p < 0.001), and treatment with systemic corticosteroids after the first surgical resection (aHR = 7.52, p = 0.002) were factors significantly associated with a risk of surgical recurrence, while cryptitis resulted in a protective factor (aHR = 0.02, p < 0.001). In conclusion, the heterogeneous spectrum of factors associated to the risk of surgical recurrence in patients with CD that underwent ileocolic resection supports the need of a personalized follow-up taking into account different clinical, surgical, and histologic features.
在接受手术的克罗恩病（CD）患者中，手术复发的预测因素仅得到部分识别。我们研究的目的是识别与手术复发风险增加相关的潜在因素。我们进行了一项单中心回顾性观察研究，纳入了根据欧洲克罗恩病和结肠炎组织（ECCO）标准诊断为CD并接受首次回结肠切除术的患者。总体而言，162例患者纳入我们的研究；其中54例因缺乏足够数据而被排除。中位随访时间为136.5个月，四分位间距为91.5 - 176.5个月，中位随访后的手术复发率为21.3%。在多变量分析中，首次手术切除时年龄≤28岁（校正风险比[aHR]=16.44，p<0.001）、当前吸烟（aHR = 15.84，p<0.001）、女性（aHR = 7.58，p<0.001）、局部淋巴结存在肉芽肿（aHR = 12.19，p<0.001）以及首次手术切除后接受全身糖皮质激素治疗（aHR = 7.52，p = 0.002）是与手术复发风险显著相关的因素，而隐窝炎是一个保护因素（aHR = 0.02，p<0.001）。总之，接受回结肠切除术的CD患者中，与手术复发风险相关的因素谱具有异质性，这支持了需要根据不同的临床、手术和组织学特征进行个性化随访。
