P390 The impact of anti-TNF therapy in adjuvant setting on postoperative recurrence patterns over decades in complicated Crohn’s disease
F. Colombo*1, A. Frontali2, L. Conti1, C. Baldi1, S. Ardizzone3, G. Maconi3, F. Corsi4, D. Foschi1, G. M. Sampietro1
1Luigi Sacco University Hospital, General Surgery, Milano, Italy, 2Hôpiteau de Paris (AP-HP), Beaujon Hospital, University Denis Diderot, Department of Colorectal Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD),, Paris, France, 3Luigi Sacco University Hospital, Gastroenterology, Milano, Italy, 4ICS Maugeri, General Surgery Department, Pavia, Italy
Surgical resection of diseased bowel in complicated Crohn's disease (CD) is frequently not curative and post-operative recurrence remains a significant problem in a large amount of patients. The aim of the study was to evaluate the impact of anti-TNF therapy in the prevention of CD patients’ surgical recurrence in a Tertiary Italian IBD Center over decades.
The Prospective Sacco Database for Surgery of CD (ProSaDS-CD) was retrospectively reviewed to analyse primary (Pr) and re-operative (Re) characteristics of patients operated on in the two decades 1994–2004 (Pr1–Re1) and 2005–2015 (Pr2–Re2). Gender, age, location, behaviour, smoking habit, perianal disease (PCD), time to surgery, indication for surgery, number and length of intestinal locations, number of resection and strictureplasty (SP), postoperative adjuvant therapy, and 25 years surgical recurrence were analysed using the chi-square test, Fisher exact test, Student’s
From the ProSaDS-CD, 807 primary and 154 recurrent patients were divided in Group-Pr1 (
Period 1 (Pr1) vs. period 2 (Pr2) postop 25 years recurrence.
In the last decade, surgery for CD has increased in paediatric patients and in the elderly, with a more aggressive pattern in terms of number and extension of locations, and penetrating complications. Strictureplasties in recurrent patients may reduce further intestinal damage. Anti-TNF-α adjuvant treatment and stop smoking seems to significantly change the course of recurrent disease.