P463 Recurrence of Crohn's disease after the first surgical intervention
Pontes García A.1, Gallardo Valverde J.M.*2, Iglesias Flores E.3, García Sanchez V.3, Díaz Lόpez C.2, Martínez Dueñas J.L.2, Medina J.2, Navarro E.2, Torres E.2, Gόmez Barbadillo J.2
1Universidad de Cόrdoba, Cόrdoba, Spain 2Universidad de Cόrdoba, Cirugía General, Cόrdoba, Spain 3Universidad de Cόrdoba, Digestivo del HURS, Cόrdoba, Spain
The Crohn Disease (CD) is characterized by a segmental and transmural inflammation that can affect the whole digestive tract. The 80% of the patients will require surgery and between 20–80% of them will suffer postoperative recurrence, which is influenced by pronostic factors and therapeutic strategies. The aim of our work is to know how the Disease Free Time (DFT) is affected by these factors and to determine the best medical-surgical strategy to reduce the percentage of relapse.
A retrospective cohort study which includes 144 patients with ileo-cecal localization of CD, who underwent the first surgical intervention between years 2005–2016 in the HURS. We measured a total of 32 variables, which are grouped in sociodemographic, risk factors, disease characteristics, surgical aspects, therapeutic prophylaxis, DFT and recurrence; being these two last variables the principle ones. A descriptive univariate analysis of the variables was performed using the SPSS program, a bivariate correlation analysis using Pearson's analysis, cross-tables, Kaplan-Meier survival analysis and Cox regression.
Recurrence correlates with smoking, since the 68.57% of recurrences are in smokers. The main surgical indication is the absence of response to treatment (31.25%), followed by obstruction (30%) and fistulas (14.58%). The inflammatory pattern is the most recurrent (44.28%) and the most typical location is ileal. The most frequent type of anastomosis is the side-to-side handsewn (75.7%), increasing the risk of recurrence when end-to-end or and end-to-side are carried out. 14.5% of patients present post-surgical complications, with dehiscence being the most frequent.
Recurrence occurs in 48.61% of patients after 88 months (range 1–170). 84.72% received preventive treatment and the 41% of those ones relapsed, versus the 91% of relapse without treatment. Salicylates, antibiotics and corticosteroids do not imply an increase in DFT or decrease in recurrence, while these differences are found when talking about immunomodulators (63.19%, most used) and anti-TNF used in 12.5% of patients. Anti-TNF reduce relapse to 22.2%, while immunomodulators only achieve 31.86%. In the survival analysis, preventive treatment with immunomodulators and/or biologicals demonstrates an increase in DFT (p<0.05).
In our attempt to reduce recurrence and increase DFT we have determined a number of prognostic factors (tobacco, side-to-side anastomosis, inflammatory pattern, preventive treatment with immunosuppressants and biological) to help us to adopt the best strategy to increase DFT in our patients. The main limitation is the reliability of the information collected from a pre-existing database and covering an extended period of time.