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P354 Early treatment versus active surveillance after ileocolic resection in Crohn’s disease: a retrospective cohort study.

Haenen, S.(1);Sabino, J.(1);Bislenghi, G.(2);D'Hoore, A.(2);Ferrante, M.(1);Vermeire, S.(1);

(1)University hospitals Leuven, Department of Gastroenterology, Leuven, Belgium;(2)University hospitals Leuven, Department of Abdominal Surgery, Leuven, Belgium

Background

Patients with Crohn’s disease (CD) often require ileocolic resection (ICR) due to refractory disease or disease-related complications, such as intestinal strictures, enteric fistulae or intra-abdominal abscesses. Up to 70% of patients will develop new endoscopic lesions in the neoterminal ileum within the first year after surgery. We assessed if the timing of postoperative treatment can reduce postoperative recurrence (POR) rate.

Methods

We performed a retrospective, single-center observational cohort study in a tertiary hospital. All CD patients undergoing abdominal surgery from January 1st 2015 until June 30th 2019 were screened. Patients with CD who underwent ileocolic resection with ileocolic anastomosis were included.  Depending on the postoperative management patients were divided in two groups: “wait and see” if medical treatment was not initiated before endoscopic evaluation 6 months after surgery (n=109), “treat” if medical treatment was initiated directly after surgery (n=49). Patients whose postoperative follow-up occurred in another center were excluded. Data were collected by review of the electronic medical charts and included patient demographics, disease characteristics (Montreal classification), medication, indication for surgery and POR assessment. POR was defined as clinical (PRO2 pain >1 or loose stool frequency >1.5), endoscopic (Rutgeerts score > i2a) or radiologic (disease activity on MR enterography necessitating treatment). Survival analysis was performed with Kaplan-Meier and Cox proportional hazards model.

Results

In total 158 patients met the inclusion criteria: 109 patients in the “wait and see” group and 49 in the “treat” group. The main baseline characteristics of the cohorts are summarized in figure 1. The main indication for surgery was stricturing disease in both groups (69.7% and 65.3%) followed by penetrating disease (42.2% and 24.5%) and refractory disease (6.4% and 20.4%). Postoperative management did not significantly influence the risk for POR (figure 2). The same was also observed in patients with known risk factors for POR (figure 3).  Patients with a high body mass index (>25 kg/m²) had a significant greater risk for developing POR (HR 1.65, CI 1.09-2.5, p=0.019; figure 4).

Figure 1
Figure 1: Baseline characteristics

Figure 2: Kaplan-Meier including all patients
Figure 2: Kaplan-Meier including all patients

Figure 3: Kaplan-Meier including patients with at least one of the following risk factors: smoking, biological or penetrating disease (B3) at surgery

Figure 3: Kaplan-Meier including patients with at least one of the following risk factors: smoking at time of surgery, biological at surgery, penetrating disease (B3) as indication for surgery

Figure 4
Figure 4: Cox proportinal hazards model

Conclusion

There was no statistical significant difference in POR between immediate treatment after ICR and active surveillance with endoscopy 6 months after surgery. Prospective randomized trials with long follow-up are needed to further explore the use of adjuvant postoperative treatment to prevent POR.

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