P586 Surgical recurrence in Crohn’s Disease: Can we prevent it?
Botto, I.(1);Serrazina, J.(1);Coelho Rodrigues, I.(1);Fernandes, S.(1);Bernardo, S.(1);Gonçalves, A.R.(1);Moura Santos, P.(1);Valente, A.(1);Correia, L.(1);Tato Marinho, R.(1);
(1)Centro Hospitalar Universitário Lisboa Norte, Serviço de Gastrenterologia, Lisbon, Portugal;
Background
Crohn’s Disease (CD) is a chronic inflammatory disease primarily affecting the bowel. In the pre-biological era, approximately 40-50% of patients would undergo surgery within the first 2 decades after diagnosis, with a risk of postoperative recurrence up to 50% at 10 years. Although post-operative prophylaxis is recommended to prevent clinical and endoscopic recurrence, little is known about the factors associated with surgical recurrence.
Methods
Single-center, retrospective study including 992 patients with CD. Demographic and clinical data were retrieved from patients’ medical charts. Patients with 1 or more surgeries were selected for analysis, excluding perianal disease surgeries. Thiopurines and biologics were considered as prophylaxis for surgical recurrence only if initiated within the first year after surgery. A logistic regression analysis was performed to evaluate potential predictors of surgery recurrence.
Results
Three hundred and nine patients (31.1%) required at least one surgery during follow-up. Two hundred and twenty-four patients (72.5%) underwent a single surgery and 85 (27.5%) required two or more interventions. Patients with surgical recurrence were younger [31 (23-36) vs 34 years (24-44), p=0.009], and had lower rates of prophylaxis with thiopurines (23.5% vs 37.5%, p=0.013), and anti-tumor necrosis factor (TNF) agents (8.2% vs 22.3%, p=0.002) compared with patients without surgical recurrence. Multivariate analysis identified stricturing and penetrating phenotype as risk factor for surgical recurrence (OR 2.292 95%CI [1.500-3.502], p<0.001]). Likewise, older age (OR 0.949 95%CI [0.94-0.996], p=0.034), and prophylaxis with anti-TNFs (OR 0.309 95% [0.126-0.754], p=0.01) were protective factors against surgical recurrence. Twenty-five patients (29.4%) developed a second surgical recurrence. Patients with more than one surgical recurrence had lower utilization of thiopurines (16% vs 45%, p=0.009) and anti-TNFs (0% vs 26.7%, p=0.002).
Conclusion
Our findings suggest that postoperative prophylaxis with immunosuppressants, especially anti-TNFs, significantly reduces the risk of surgical recurrence. Postoperative prophylaxis should be implemented in high-risk patients, especially younger patients and those with a non-inflammatory phenotype.