Risk factors for re-resection in Crohn’s disease revealed

In patients with Crohn’s disease (CD), a primary resection with colon involvement and an isolated small bowel resection were associated with an increased risk of re-resection, compared with patients who received ileocecal resection, results of a population-based study indicated. Furthermore, administering biologic therapy may reduce the risk of re-resection in subgroups of patients.

“In Crohn’s disease, there is a decline in resection rates but not in re-resection rates,” expressed Dr Anja Poulsen (Copenhagen University, Denmark) [1]. The current population-based study aimed to describe the re-resection rates for patients with CD and to identify disease-modifying factors and risk factors associated with disease recurrence and re-resection. The authors identified 631 Danish patients who had undergone primary resection for CD [2].

“The cumulative risk of re-resection due to disease activity was 3.6% at 1 year, 10.1% at 5 years, and 14.1% at 10 years,” stated Dr Poulsen. Also, the median time from primary resection to disease recurrence was 11.0 months, with corresponding disease recurrence rates of 36.9% at 1 year, 66.1% at 5 years, and 73.6% at 10 years (see Figure). Next, Dr Poulsen mentioned that the most commonly performed resections were a ‘simple ileocecal resection’ (60.0%), an ‘ileocecal resection with colon ascendens included’ (10.0%), and a ‘more extensive ileocecal resection’ (7.8%). “Importantly, patients undergoing a simple ileocecal resection as primary surgery had a re-resection risk of 6.3%, whereas those who underwent a small bowel resection or had a part of the colon included in the primary resection had re-resection risks of 14.3% and 19.0%, respectively. Furthermore, there was a reduced risk of re-resection in patients with B2 or B3 disease types who received biological therapy within the first year after primary resection (B2: HR 0.56; 95% CI 0.34–0.93; P=0.026; B3: HR 0.31; 95% CI 0.15–0.64; P=0.002). Finally, prophylactic biological therapy after a primary ileocecal resection appeared to reduce the risk of post-operative disease recurrence and re-resection (HR 0.58; 95% CI 0.34–0.99; P=0.047).

Figure: Time from primary resection to disease recurrence [2]



CTA, computed tomography angiography; IUS, intestinal ultrasonography; MRI, magnetic resonance imaging; SES-CD, simple endoscopic score for Crohn’s disease.

The current study provided insights into re-resection rates and associated risk factors in patients with CD. Disease phenotype, involved segments in the primary resection procedure, and biological therapies appear to influence the risk of disease recurrence and re-resection in these patients.

1. Tsai L, et al. Clin Gastroenterol Hepatol. 2021;19(10):2031-2045.e11.
2. Poulsen A, et al. Risk of disease recurrence and re-resections in Crohn’s disease patients undergoing primary bowel resection: a population-based study. OP34, 19^th Congress of ECCO, 21–24 February 2024, Stockholm, Sweden.

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Posted on 18 April 2024