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P457 Complications and disease recurrence after primary ileocecal resection in paediatric Crohn’s disease: a multicentre cohort analysis

K. Diederen*1, L. de Ridder2, P. van Rheenen3, V. Wolters4, L. Mearin5, G. Damen6, T. de Meij7, H. van Wering8, L. Tseng1, M. Oomen9, J. de Jong9, M. Benninga1, A. Kindermann1

1Academic Medical Centre, Department of Paediatric Gastroenterology and Nutrition, Amsterdam, Netherlands, 2Erasmus MC-Sophia Children’s Hospital, Department of Paediatric Gastroenterology, Rotterdam, Netherlands, 3University Medical Centre Groningen, Department of Paediatric Gastroenterology, Groningen, Netherlands, 4University Medical Centre Utrecht, Department of Paediatric Gastroenterology, Utrecht, Netherlands, 5Leids Universitair Medisch Centrum, Department of Paediatrics, Leiden, Netherlands, 6Radboud University Medical Centre, Department of Paediatric Gastroenterology, Nijmegen, Netherlands, 7VU University Medical Centre, Department of Paediatric Gastroenterology, Amsterdam, Netherlands, 8Amphia Hospital, Department of Paediatrics, Breda, Netherlands, 9Academic Medical Centre, Department of Paediatric Surgery, Amsterdam, Netherlands

Background

Up to 25% of paediatric-onset Crohn’s disease (CD) patients undergo surgical resection before adulthood. Limited data are available on the complications and long-term outcome of surgery in children with CD. Therefore, we aimed to investigate the complication and disease recurrence rate after primary ileocecal resection for paediatric CD and identify predictors for complications and disease recurrence.

Methods

A retrospective cohort analysis was performed of all children (aged <18 years) who underwent primary ileocecal resection for CD between 1990 and 2015 at 7 tertiary hospitals in the Netherlands. Severe complications, defined as requiring surgical, endoscopic or radiological intervention, as well as associated risk factors, were assessed. Time to clinical recurrence, defined as active disease requiring a step up in medical treatment, and surgical recurrence, defined as disease recurrence requiring intra-abdominal surgery, was analysed using Kaplan–Meier estimates. Postoperative maintenance therapy was defined as mesalazines, thiopurines, methotrexate, or anti-TNF agents started within 3 months after ileocecal resection. Multivariate logistic and Cox regression analyses of risk factors were performed for severe complications and recurrence, respectively.

Results

We identified 122 children with CD who underwent primary ileocecal resection (52% male; mean age at surgery 15.2 years [SD 1.6]) for stenosis (61%), therapy refractory inflammation (27%), and intra-abdominal fistulae or abscesses (11%). The majority of patients (57%) had isolated ileal disease. Median time from diagnosis to surgery was 11 months (IQR 3–31), and median follow-up after surgery was 4 years (IQR 1–10). Further, 16 patients (13%) developed a severe postoperative complication, 8 of whom (7%) had an anastomotic leak. Concurrent colonic disease [OR 4.82 (95% CI 1.38–16.90) p = 0.014] was an independent risk factor for a severe complication. Clinical and surgical recurrence rates after 1, 5,and 10 years were 18%, 46%, 69% and 3%, 10%, 23% respectively. Postoperative maintenance therapy was an independent protective factor for clinical (HR 0.16 [95% CI 0.08–0.31] p < 0.001) and surgical (HR 0.25 [95% CI 0.10–0.65] p < 0.001) recurrence. Male gender (HR 0.53 [95% CI 0.31–0.93] p = 0.027) was an independent protective factor for clinical recurrence.

Conclusion

Ileocecal resection is a very effective treatment for paediatric CD. However, children should be carefully monitored, because the severe postoperative complications rate is relatively high. Ileocolonic disease is a risk factor for severe postoperative complications. Moreover, postoperative maintenance therapy was a protective factor for both clinical and surgical recurrence.