Ten Bokkel Huinink Sebastiaan, Bak Michiel T J, Beelen Evelien M J, Erler Nicole S, Silverberg Mark S, Allez Matthieu, Hoentjen Frank, Bodelier Alexander G L, Dijkstra Gerard, Romberg-Camps Marielle, de Boer Nanne K H, Stassen Laurents P S, van der Meulen-de Jong Andrea E, West Rachel L, van der Woude C Janneke, van Ruler Oddeke, de Vries Annemarie C
Department of Gastroenterology and Hepatology, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands.
Department of Biostatistics, Erasmus Medical Center, Rotterdam, the Netherlands.
Aliment Pharmacol Ther. 2025 Mar;61(6):1019-1031. doi: 10.1111/apt.18496. Epub 2025 Jan 24.
The impact of prophylactic medication following ileocecal resection (ICR) for Crohn's disease (CD) merits further elucidation. Prophylactic medication following ileocecal resection (ICR) is recommended in patients with Crohn's disease (CD), particularly in patients at increased risk of recurrence, but the impact on long-term outcomes needs to be further elucidated.
To evaluate the effect of postoperative prophylactic medication on long-term prognosis.
A retrospective cohort study was performed in patients with CD who underwent primary ICR between 2000-2020 in the Netherlands. Patients were divided into two groups: postoperative prophylactic medication [< 12 weeks following ICR] versus no postoperative prophylactic medication. Outcomes were surgical recurrence [re-resection for CD], severe endoscopic recurrence [modified Rutgeerts score (mRS) ≥ i3] and endoscopic or radiologic recurrence [mRS ≥ i2b or radiologic recurrence]. Inverse probability of treatment weighting [IPTW] method was used to adjust for confounding and selection bias. Survival and association between postoperative prophylactic medication and outcomes were assessed with Kaplan-Meier analyses and Cox proportional hazard models.
807 patients underwent ICR (median follow-up 5.0 years); 36% received postoperative prophylactic medication. Surgical, severe endoscopic and endoscopic or radiologic recurrence rates were significantly lower in those who received prophylactic medication (p = 0.01; p < 0.01; p < 0.01). IPTW analysis showed a lower risk of severe endoscopic and endoscopic or radiologic recurrence in patients treated with postoperative prophylactic medication (aOR 0.64; 95% CI 0.43-0.97; aOR 0.65; 95% CI 0.47-0.91), which also was identified as a protective factor for severe endoscopic (aHR 0.5; 95% CI 0.4-0.6) and endoscopic or radiologic recurrence (aHR 0.6, 95% CI 0.5-0.7) in multivariable analysis after correction for confounding factors. A comparable protective effect of postoperative prophylactic medication was sustained in patients who underwent ileocolonoscopy <1 year postoperatively and who underwent surgery on or after 2010.
Prophylactic medication following primary ICR significantly reduces long-term recurrence rates in CD and was identified as a protective factor for severe endoscopic and endoscopic or radiologic recurrence.
回盲部切除术（ICR）治疗克罗恩病（CD）后预防性用药的影响值得进一步阐明。克罗恩病（CD）患者推荐在回盲部切除术（ICR）后进行预防性用药，尤其是复发风险增加的患者，但对长期预后的影响需要进一步阐明。
评估术后预防性用药对长期预后的影响。
对2000年至2020年在荷兰接受初次ICR的CD患者进行回顾性队列研究。患者分为两组：术后预防性用药[ICR后<12周]与未进行术后预防性用药。观察指标为手术复发[因CD再次手术]、严重内镜复发[改良鲁杰尔斯评分（mRS）≥i3]和内镜或影像学复发[mRS≥i2b或影像学复发]。采用治疗权重逆概率（IPTW）方法调整混杂因素和选择偏倚。通过Kaplan-Meier分析和Cox比例风险模型评估术后预防性用药与观察指标之间的生存情况和相关性。
807例患者接受了ICR（中位随访5.0年）；36%的患者接受了术后预防性用药。接受预防性用药的患者手术、严重内镜及内镜或影像学复发率显著降低（p = 0.01；p < 0.01；p < 0.01）。IPTW分析显示，术后接受预防性用药的患者严重内镜及内镜或影像学复发风险较低（调整后比值比[aOR] 0.64；95%置信区间[CI] 0.43 - 0.97；aOR 0.65；95% CI 0.47 - 0.91），在校正混杂因素后的多变量分析中，这也被确定为严重内镜复发（调整后风险比[aHR] 0.5；95% CI 0.4 - 0.6）和内镜或影像学复发（aHR 0.6，95% CI 0.5 - 0.7）的保护因素。术后预防性用药在术后<1年接受回结肠镜检查的患者以及2010年及以后接受手术的患者中具有类似的保护作用。
初次ICR后预防性用药可显著降低CD的长期复发率，并被确定为严重内镜及内镜或影像学复发的保护因素。
