DOP77 Is durable remission achievable after ileocolic resection for Crohn’s disease ? Long-term results of a prospective multicentric cohort study of the GETAID Chirurgie
Abdalla, S.(1)*;Benoist, S.(1);Maggiori, L.(2);Lefevre, J.(3);Denost, Q.(4);Cotte, E.(5);Germain, A.(6);Beyer-Berjot, L.(7);Desfourneaux, V.(8);Rahili, A.(9);Duffas, J.P.(10);Pautrat, K.(11);Denet, C.(12);Bridoux, V.(13);Meurette, G.(14);Faucheron, J.L.(15);Loriau, J.(16);Souche, F.R.(17);Corte, H.(2);Zerbib, P.(18);Panis, Y.(19);Brouquet, A.(1);
(1)Le Kremlin-Bicetre University Hospital, Department of Digestive Surgery, Le Kremlin-Bicetre, France;(2)Saint-Louis University Hospital, Department of Digestive Surgery, Paris, France;(3)Saint-Antoine Hospital, Department of Digestive Surgery, Paris, France;(4)Bordeaux University Hospital, DEpartment of Digestive Surgery, Bordeaux, France;(5)Lyon-Sud University Hospital, Department of Digestive Surgery, Pierre-Benite, France;(6)Nancy University Hospital, Department of Digestive Surgery, Nancy, France;(7)Marseille University Hospital, Department of Digestive Surgery, Marseille, France;(8)Rennes University Hospital, Department of Digestive Surgery, Rennes, France;(9)Nice University Hospital, Department of Digestive Surgery, Nice, France;(10)Toulouse University Hospital, Department of Digestive Surgery, Toulouse, France;(11)Lariboisière University Hospital, Department of Digestive Surgery, Paris, France;(12)Institut Mutualiste Montsouris, Department of Digestive SUrgery, Paris, France;(13)Rouen University Hospital, Department of Digestive Surgery, Rouen, France;(14)Nantes University Hospital, Department of Digestive Surgery, Nantes, France;(15)Grenoble University Hospital, Department of Digestive Surgery, Grenoble, France;(16)Saint-Joseph Hospital, Department of Digestive Surgery, Paris, France;(17)Montpellier University Hospital, Department of Digestive Surgery, Montpellier, France;(18)Lille University Hospital, Department of Digestive Surgery, Lille, France;(19)Beaujon University Hospital, Department of Digestive Surgery, Clichy, France; GETAID Chirurgie
Background
Most of the patients undergoing bowel resection for Crohn’s disease (CD) develop postoperative recurrence requiring medical treatment intensification or surgery. Is there a subgroup of patients for which surgery allows durable remission?
Methods
In this retrospective follow-up study, we collected data from 592 patients undergoing ileocolic resection for CD who were included from 2013 to 2015 in a prospective nation-wide cohort of the GETAID Chirurgie group. Patients with follow-up superior to 36 months were included. Primary outcome was durable remission, defined as the absence of endoscopic recurrence (Rutgeerts ≥i2) and/or absence of medical treatment intensification. Uni- and multivariate analyses of the predictive factors for durable remission were carried out.
Results
Among 268 included patients, 158 (59%) had a B2 stricturing phenotype, 92 (34%) had a B3 penetrating phenotype and 18 (7%) had a non-stricturing non-perforating phenotype (Montreal classification). One hundred and eighty-eight patients (70%) had a primary ileocolic resection. One hundred and sixty-seven patients (66%) had postoperative medical treatment to prevent postoperative recurrence (Table 1). After a median follow-up of 85 (36-104) months, 52 patients (19%) had a durable remission, among which 24 (46%) had no medical treatment and 28 (54%) maintained the same postoperative prophylactic treatment, including anti-TNF therapy in 15 patients (54%) (Table 2). Durable remission rate was significantly increased in B1 phenotype vs B2/B3 (n=7/18 ;39% vs n=45/250; 18%, p=0.030) and in primary ileocolic resection vs redo ileocolic resection (n=43/184 ; 23% vs n=9/80 ; 11%, p=0.023). In multivariate analysis, B1 phenotype was an independent predictive factor for durable remission (OR=3.59, IC95%[1.13-11.37], p=0.030) (Table 3). 
Conclusion
These long-term data obtained from a nation-wide prospective cohort are in line with those of a randomised controlled trial (LIR!C) and show that durable remission is obtained in nearly 40% of CD patients with non-stricturing non-penetrating phenotype operated for CD refractory to medical treatment. This important result should be considered when medical treatment intensification versus surgery is discussed in these patients.