Predictivity of early and late assessment for post-surgical recurrence of Crohn's disease: Data from a single-center retrospective series.
Adolescent
Adult
Colectomy
Colon
/ surgery
Colonoscopy
/ statistics & numerical data
Crohn Disease
/ diagnosis
Female
Humans
Ileum
/ surgery
Male
Postoperative Period
Predictive Value of Tests
Prognosis
Recurrence
Retrospective Studies
Risk Assessment
Time Factors
Ultrasonography
/ statistics & numerical data
Young Adult
Assessment
Endoscopy
Postoperative Crohn's disease
Recurrence
Ultrasonography
Journal
Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver
ISSN: 1878-3562
Titre abrégé: Dig Liver Dis
Pays: Netherlands
ID NLM: 100958385
Informations de publication
Date de publication:
Aug 2021
Aug 2021
Historique:
received:
12
07
2020
revised:
20
09
2020
accepted:
21
09
2020
pubmed:
3
2
2021
medline:
3
2
2022
entrez:
2
2
2021
Statut:
ppublish
Résumé
Post-surgical recurrence of Crohn's disease (CD) after ileocolonic resection is common. Early identification of features associated with recurrence is a standard procedure of postoperative management, but the prognostic role of such features when detected at later time points is unclear. We compared the predictivity for Crohn's disease recurrence of common clinical-instrumental variables when assessed early (<12 months) or late (>36 months) after surgery. This retrospective study considered CD patients who had ileocolonic resection and were followed for a median of 7.6 years. Clinical characteristics, post-surgical therapy, endoscopy recurrence (Rutgeerts' score ≥i2) and ultrasound features were compared between subgroups who had a early or late post-surgical assessment. Univariate and multivariate analyses were done to identify variables associated with recurrence (clinical and surgical). Of 201 patients, 70 (32%) had a early and 39 (19%) had a late post-surgical assessment. The Early and Late subgroups had similar clinical characteristics. Overall, clinical relapse was observed in 131 patients (66%), surgical relapse in 31 (16%), endoscopic recurrence in 149 (75%) and ultrasonographic recurrence in 132 (66%), without significant differences in frequencies between subgroups. By Cox proportional hazard regression, endoscopic recurrence was a significant predictor of clinical recurrence overall (HR=2.31, P = 0.002) and in the Early (HR=3.85, P = 0.002) but not Late subgroup. The most informative postoperative CD assessment is the one done within the first year of surgery. Later endoscopic evaluations have no prognostic value and should be done only for clinical needs or for research purposes.
Sections du résumé
BACKGROUND AND AIMS
OBJECTIVE
Post-surgical recurrence of Crohn's disease (CD) after ileocolonic resection is common. Early identification of features associated with recurrence is a standard procedure of postoperative management, but the prognostic role of such features when detected at later time points is unclear. We compared the predictivity for Crohn's disease recurrence of common clinical-instrumental variables when assessed early (<12 months) or late (>36 months) after surgery.
METHODS
METHODS
This retrospective study considered CD patients who had ileocolonic resection and were followed for a median of 7.6 years. Clinical characteristics, post-surgical therapy, endoscopy recurrence (Rutgeerts' score ≥i2) and ultrasound features were compared between subgroups who had a early or late post-surgical assessment. Univariate and multivariate analyses were done to identify variables associated with recurrence (clinical and surgical).
RESULTS
RESULTS
Of 201 patients, 70 (32%) had a early and 39 (19%) had a late post-surgical assessment. The Early and Late subgroups had similar clinical characteristics. Overall, clinical relapse was observed in 131 patients (66%), surgical relapse in 31 (16%), endoscopic recurrence in 149 (75%) and ultrasonographic recurrence in 132 (66%), without significant differences in frequencies between subgroups. By Cox proportional hazard regression, endoscopic recurrence was a significant predictor of clinical recurrence overall (HR=2.31, P = 0.002) and in the Early (HR=3.85, P = 0.002) but not Late subgroup.
DISCUSSION
CONCLUSIONS
The most informative postoperative CD assessment is the one done within the first year of surgery. Later endoscopic evaluations have no prognostic value and should be done only for clinical needs or for research purposes.
Identifiants
pubmed: 33526411
pii: S1590-8658(20)30917-8
doi: 10.1016/j.dld.2020.09.018
pii:
doi:
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
987-995Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2020 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of Competing Interest GDP, MM, MM, CR, PM, MC, CR, EM, EE, AL, RR, AF: reported no conflict of interest to disclose CG: Roche boards MD: Advisory board/Lecturer/Grants/Congress participation from Abbvie, Takeda, Janssen, Ferring, MSD, Mundipharma, Pfizer, SOFAR, Chiesi, Roche, Bioclinica