Loading ...

TOPLINE:

Among patients who had a second surgery for Crohn’s disease over the past two decades, about 12% underwent a third surgery within 5 years due to disease recurrence. This rate remained stable despite the increased use of advanced therapies over the duration of the study, a retrospective analysis showed.

METHODOLOGY:

• One third of patients with Crohn’s disease undergo major abdominal surgery — usually an ileocolic resection — within 5 years of diagnosis. Although repeat resection of the neoterminal ileum is common, its long-term outcomes and the effect of newer medical therapies remain unclear.
• Investigators in Amsterdam conducted a single-center retrospective study to assess the risk for a third surgery in 110 adults with Crohn’s disease (median age, 39 years; 62.7% women) who underwent a second surgery between January 2000 and December 2021.
• The analysis compared patients who underwent their second surgery between 2000 and 2009 with those treated between 2010 and 2021 to evaluate changes in surgical outcomes over time.
• Medical records were used to retrieve data on patient characteristics, medication history for inflammatory bowel disease, surgical characteristics, and postoperative disease recurrence. Advanced medical therapy included biologics such as anti-TNF agents and/or small molecules such as upadacitinib.
• The primary outcome was the need for a third surgery due to disease recurrence in the neoterminal ileum and/or at the anastomotic site over a median follow-up of 126 months.

TAKEAWAY:

• A total of 35 patients underwent a third surgery, 77% of which were due to stricturing disease. The 5-year cumulative rate of a third surgery was 12.1%, and the 10-year cumulative rate was 24.9%.
• The use of advanced prophylactic therapies increased substantially from 2000-2009 to 2010-2021 (16.4% vs 41.7%; P = .004), yet 5-year rates of a third surgery did not differ across study periods.
• The risk for a third surgery was similar between patients who received advanced prophylactic therapies within 3 months of the second surgery and those who did not (hazard ratio [HR], 0.87; 95% CI, 0.37-2.02; P = .74).
• A history of treatment with immunomodulators or advanced therapies between the first and second surgeries was associated with an increased risk for a third surgery (HR, 2.90; P = .04).

IN PRACTICE:

“Postoperative management has significantly evolved with the introduction of immunomodulators, anti-TNF therapy, small molecules, and strict endoscopic disease monitoring, aiming to reduce the risk of recurrence,” the authors of the study wrote.

“It is concerning, however, that over the past two decades, no improvement has been observed in the 5-year rates of third surgery,” they added.

SOURCE:

This study was led by Anouck E.G. Haanappel, MD, Amsterdam University Medical Center, Amsterdam, the Netherlands. It was published online in the Journal of Crohn’s and Colitis.

LIMITATIONS:

Owing to the retrospective design of this study, some data may have been missing. The true effect of treatment may have been underestimated as the patients at higher risk may have been more likely to receive advanced prophylactic therapies. The patients were recruited from a tertiary referral center, which may have limited generalizability to broader populations.

DISCLOSURES:

This study did not receive any specific funding. Two authors reported receiving unrestricted research grants and speaker’s fees from, and/or serving on the advisory board for several pharmaceutical and healthcare companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.