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P197 Crohn’s disease recurrences after surgery: is there something new?

L. Campanati1, M. Giulii Capponi1, M. Marini*1, M. Lotti1, E. Poiasina1, M. Pisano1, N. Paderno1, N. Allievi1, R. Ragozzino1, A. Indriolo2, A. Lucianetti1

1ASST Papa Giovanni XXIII, General and Emergency Surgery, Bergamo, Italy, 2ASST Papa Giovanni XXIII, Gastroenterology and Digestive Endoscopy, Bergamo, Italy

Background

In our institution, a multi-disciplinary team consisting of endoscopists, surgeons, nutritionists, and pathologists is involved in the management of inflammatory bowel diseases. Over the last 18 years, data have been collected in a dedicated database. We retrospectively reviewed our activity to analyse whether the biological agents introduction influenced the treatment strategies in Crohn’s disease (CD) patients who required a second surgery.

Methods

We retrospectively reviewed our database from 2000 to 2012 and selected patients with at least 6-year follow-up who underwent major surgery almost once in their life, including those previously treated in other centres. These patients were divided into four groups according to the medical treatment administered after surgery: patients treated with biologic agents (anti-TNFa) (Group A), with immunosuppressive drugs (azathioprine) (Group B), with immunosuppressive and biologic therapy (Group C) and with 5-aminosalicylic (5-ASA) (Group D). The difference between groups were calculated with χ2 test.

Results

From 2000 to 2012, 206 patients with CD referred to our hospital. Among them, 137 patients underwent major surgery at least once in their life. After surgery, 23 patients were treated with biologic agents (Group A), 39 with immunosuppressive drugs (Group B), 51 with immunosuppressive and biologic therapy (Group C) and 24 with 5-ASA (Group D). Overall, 31 patients surgically recurred even though the medical therapy. Patients’ surgical recurrence data are shown in Table 1 according to the pre-operative medical treatment. The reasons for re-operations are summarised in Table 2.

Total, n = 137Group A, n = 23Group B, n = 39Group C, n = 51Group D, n = 24p-value
Number of reoperated patients, n (%)31 (23)5 (22)9 (23)8 (16)9 (38)0.30
Mean interval between surgeries (months)8698798977
Number of patients treated with >2 surgeries, n (%)11 (8)3 (13)6 (15)2 (4)0.07

Surgical recurrence data according to the medical treatment at the time of the re-operation.

Total, n = 31Group A, n = 5Group B, n = 9Group C, n = 8Group D, n = 9
Stricture or obstruction, n (%)19 (61)3 (60)5 (55)5 (63)6 (67)
Intractable fistula, n (%)6 (19)1 (20)1 (11)2 (25)2 (22)
Intra-abdominal abscess, n (%)4 (13)1 (20)2 (22)1 (11)
Perforation, n (%)2 (6)1 (11)1 (12)

Reasons of reoperation among medical treatment groups.

Conclusion

According to our data, none of the currently available drugs can significantly reduce alone the re-operation rate for CD. The combined use of immunosuppressive and biologic drugs does not seem to be the convincing strategy to delay surgical recurrence in Crohn’s disease.