PROGNOSTIC FACTORS FOR POSTOPERATIVE RECURRENCE OF CROHNS-DISEASE

Prognostic factors for postoperative recurrence of Crohn's disease (CD ) have been widely investigated but not yet clearly identified. PURPOS E: Aim of this study was, therefore, to analyze the association betwee n demographic, clinical, laboratory, and surgical characteristics of p atients and the cumulative probability of endoscopic postoperative rec urrence. METHODS: The study was performed in 110 patients who were enr olled in the Italian multicenter, randomized, controlled trial on the effectiveness of 5-aminosalicylic acid (5-ASA) in the prevention of po stoperative recurrence in CD. Patients had undergone their first intes tinal resection for CD of the terminal ileum with or without involveme nt of cecum ascending colon. Recurrence was defined on the basis of en doscopy. The following variables were evaluated as potential prognosti c factors: gender, age, years since diagnosis, clinical course (perfor ative and nonperforative), Crohn's Disease Activity Index score, white blood count, erythrocyte sedimentation rate, C-reactive protein, and orosomucoids assessed before the operation. Timing of operation (elect ive or urgent), type of anastomosis (end-to-end, end-to-side, side-to- end, side-to-side), and prophylactic treatment were also evaluated. Co lon ileoscopy was performed at 6, 12, 24, and 36 months after operatio n. The association between variables and the cumulative proportion of recurrence was analyzed both by univariate analysis (life table method , log-rank test) and multivariate regression analysis (Cox's model, st epwise procedure). RESULTS. Results of this study indicate that, of th e features considered before surgery, only leukocytosis (white blood c ount, >9,000 mi) was significantly associated with an increased risk o f recurrence: (P < 0.05) at univariate analysis. This finding was not confirmed by multivariate analysis. A trend toward a higher risk of re currence for patients who have had a resection with end-to-end anastom osis compared with those who have had a resection and other types of a nastomosis was also observed. This trend reached significancy in the g roup of patients submitted to treatment with 5-ASA. The multivariate a nalysis showed that 5-ASA-treated patients with end-to-end anastomosis had a risk of recurrence more than threefold higher than those with o ther types of anastomosis (relative risk, 3.40; 95 percent confidence interval, 1.00-11.96; P < 0.03). CONCLUSIONS: From a practical point o f view, it has been estimated that the combination of intestinal resec tion plus side-to-side or end-to-side anastomosis with oral 5-ASA trea tment reduces by 64 percent the postoperative recurrence rate in CD at three years follow-up.