P194 Post-operative recurrence of Crohn’s disease after resection ileocecal: prevalence and risk factors
A. Hammami*1, A. Ben Slama1, M. Ksiaa1, H. Jaziri1, M. Ben Rejeb2, M. Ben Mabrouk3, A. Souguir1, I. Ben Mansour1, S. Ajmi1, A. Brahem1, A. Jmaa1
1Hospital university of Sahloul, Gastroenterology, Sousse, Tunisia, 2Hospital university of Sahloul, Sousse, Tunisia, 3Hospital university of Sahloul, surgery, Sousse, Tunisia
The rate of intestinal resection in patients with Crohn’s disease can attend 49% and 64%, respectively after 10 and 30 years of diagnosis. Despite preventive therapy, clinical recurrence 1 year after surgical treatment concerns 20% to 30% of patients. The objective of our study was to study the prevalence of clinical postoperative recurrence in Crohn’s disease after ileocecal resection, and to determine predictive factors of the recurrence.
We conducted a descriptive study over 10-year period, including all patients with Crohn’s disease who underwent ileocecal resection.
From 240 patients with Crohn’s disease, 86 underwent ileocecal resection (35.8%), with a mean follow-up of 5.8 years (2–13 years). The average age of our patients was 32.95 years (16–69) and 46.5% of patients were smokers. According to the Montreal classification, the disease was located in the ileum in 55 patients (64%) and the ileocecum in 31 patients (36%). A penetrating phenotype was present in 23 patients, and 12 patients had perianal lesions. Surgical treatment was indicated for small bowel obstruction in 65 cases (75.6%), abscess in 12 cases (13.9%), perforation in 6 cases (7%), and fistula in 3 cases (3.5%). The average length of the small bowel resected was 13.2 cm (8–105 cm). We prescribed postoperative medical treatment for 68 patients (79.1%) in an average of 33 days (4–116 days) after surgery. Further, 19 patients were under 5ASA therapy (22.1%), 47 cases under azathioprine (54.7%), and 2 patients received anti-tumour necrosis factor (TNF) therapy (2.3%), and18 patients (20.9%) did not receive any medication with good outcome.
During follow-up, clinical recurrence was observed in 24.4% of our patients (9.3% at 1 year and 20.9% at 5 years) with a mean period of 34.6 months (8–116 months). Predictors of postoperative recurrence in univariate analysis were lack of post-operative smoking cessation, the inaugural complications, ileal location, an interval between diagnosis and surgery < 9.5 months, and healthy resection margins < 2 cm. In a multivariate study, independent factors of postoperative recurrence were absence of postoperative smoking cessation, the period between diagnosis and surgery < 9.5 months, and margins of resection < 2 cm.
The clinical recurrence is common after ileocecal resection in Crohn’s disease. Tobacco use, early surgery, and margins of resection < 2 cm were predictive of postoperative recurrence.