P671 The 5 year incidence of post-operative clinical recurrence following ileocolonic resection for terminal ileal Crohn's disease
P. Morar*, O. Faiz, A. Hart, J. Warusavitarne
St Mark's Hospital, Colorectal Surgery & IBD Unit, London, United Kingdom
Post-operative clinical recurrence following ileocolonic resection for Crohn's disease is common. It can occur in up to 55% of patients within 5 years . Current predictors include smoking, redo surgery and penetrating disease . The aims of this study were to determine the 5 year incidence and predictors of post-operative clinical recurrence following ileocolonic resection in terminal ileal Crohn's disease.
The clinical records of patients who underwent ileocolonic resection for Crohn's disease over a six year timeframe (1st January 2005 to 31st December 2010) were reviewed. Post-operative clinical recurrence was defined as an initiation or change in medical therapy for recurrent symptoms, with endoscopic or radiological evidence of active Crohn's disease. Life table analysis was used to determine the 5 year incidence of post-operative clinical recurrence. The Kaplan-Meier model and Log Rank test was used to determine predictors of post-operative clinical recurrence (P values < 0.05 were considered significant).
There were 175 ileocolonic surgical procedures [142 one-stage and 33 two-stage procedures (13 stoma reversals and 20 stoma formations)] performed on 163 patients. Long-term follow-up data were obtained on 142 patients. Six patients received biologics preoperatively and continued biologics postoperatively. Three additional patients received biologics postoperatively. Life table analysis demonstrated 48.2% of patients with post-operative clinical recurrence at 5 years.
“Figure 1- Life table analysis demonstrating the proportion of patients in remission. Each drop in the curve represents a patient developing clinical recurrence”
Kaplan-Meier analyses demonstrated redo surgery [P = 0.016], ileocolonic (Montreal L3) disease [P = 0.049], and the presence of postoperative intra-abdominal septic complications (IASCs) [P = 0.043] were associated with post-operative clinical recurrence.
The marginal improvement in the 5 year incidence of postoperative clinical recurrence may be indicative of a drive for multidisciplinary care as well as improved medical regiments. A risk stratification model is necessary to target high risk patients. This model may also need to include patients who develop postoperative IASCs, redo surgery and ileocolonic disease.
 Nygaard K, Fausa O, (1977), Crohn's Disease Recurrence after Surgical Treatment, Scandinavian Journal of Gastroenterology, 577-584, National Hospital of Norway
 De Cruz, P. Kamm, M. A. Prideaux, L. Allen, P. B. Desmond, P. V., (2012), Postoperative recurrent luminal Crohn's disease: A systematic review, Inflammatory Bowel Diseases, 758-777