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P395 Postoperative immunosuppressive therapies decrease the risk of second intestinal surgery in patients with Crohn’s disease: a retrospective cohort study

Y. Nagata*1,2, M. Esaki3, Y. Fuyuno2, Y. Okamoto2, S. Fujioka2, A. Hirano2, J. Umeno2, T. Torisu2, T. Moriyama2, S. Nakamura1, T. Kitazono2

1Steel Memorial Yawata Hospital, Department of Gastroenterology, Fukuoka, Japan, 2Kyushu University, Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Fukuoka, Japan, 3Saga University Hospital, Department of Endoscopy, Saga, Japan

Background

In patients with Crohn’s disease (CD), postoperative recurrence frequently occurs and a certain proportion of patients require second intestinal surgery during the clinical course. Immunomodulators (IM) and anti-tumour necrosis factor-alpha (anti-TNF) agents can be prophylactic against postoperative recurrence, however, it remains unclear whether such medications can decrease second intestinal surgery in CD. The present study aimed to investigate the preventive effect of postoperative medications on the second intestinal surgery in postoperative CD.

Methods

This is a retrospective cohort study. 112 CD patients who had undergone initial intestinal surgery during 2002 and 2017 in our institutions were enrolled. Postoperative clinical course of the patients was carefully reviewed, and possible factors associated with second intestinal surgery were investigated. Medications initiated within a year after surgery was defined as the postoperative therapies. Intestinal resection due to complication of CD or strictureplasty was defined as intestinal surgery. Cumulative probabilities of second intestinal surgery were estimated using Kaplan–Meier method, and compared by the log-rank test. Cox proportional hazard model was used to analyse factors associated with second intestinal surgery.

Results

Of the 112 patients, IM and anti-TNF agent were applied to 25 (22%) and 58 (52%) patients as the postoperative medications, respectively. Among them, both medications were used in 14 patients (13%). During median follow-up of 60.5 months, 30 patients (27%) required second intestinal surgery. Cumulative probabilities of second intestinal surgery were estimated to be 19.4% at 5 years, and 33.4% at 10 years after surgery, respectively. Under univariate analysis, clinical characteristics including age at diagnosis, smoking status and CD behaviour were not associated with second intestinal surgery. However, postoperative IM and anti-TNF agent were associated with reduced risk of second intestinal surgery (p = 0.014 and 0.047, respectively). The multi-variate analysis by Cox proportional hazard model revealed that postoperative IM [hazard ratio (HR); 0.12, 95% confidence interval (CI); 0.01–0.54] and anti-TNF agent [HR; 0.40, 95% CI; 0.15–0.96] were independent factors associated with the reduced risk of second intestinal surgery.

Conclusion

Both postoperative IM and anti-TNF agent might decrease the risk of second intestinal surgery in patients with CD.