FACTORS INFLUENCING RECURRENCE IN CROHNS-DISEASE - AN ANALYSIS OF A CONSECUTIVE SERIES OF 353 PATIENTS TREATED WITH PRIMARY SURGERY

PURPOSE: This study was undertaken to investigate the factors that inf luenced the risk of symptomatic recurrence in patients with Crohn's di sease who were treated with primary resective surgery. METHODS: Data r egarding age, gender, time from diagnosis to surgery, medication, preo perative infectious complications, laboratory values, emergency/electi ve surgery, location and extent of disease, and resection margins were analyzed in relation to recurrence in 353 patients who were undergoin g a ''curative'' resection in 1969 to 1986. RESULTS: Univariate analys es showed a higher risk of recurrence in women with ileal and ileocolo nic disease than in men (P < 0.05), in patients with ileocolonic disea se compared with those with isolated ileal disease (P < 0.05), and in ileal disease patients with an increased disease extent (P < 0.05). In a multivariate analysis performed on patients with ileal disease, inc reased disease extent, limited resection on the colonic side, and refe rral from other hospitals were three independent variables that indica ted an increased risk of recurrence (P < 0.05). Length of disease-free resection margins did not influence the risk of recurrence either in univariate or in multivariate analysis (P > 0.05). CONCLUSIONS: Diseas e extent has prognostic value regarding the risk of symptomatic recurr ence in Crohn's disease, whereas the length of resection margins does not influence the risk of relapse. These results favor a conservative approach, particularly in patients with extensive disease.