The impact of clinical types of disease manifestation on the risk of earlypostoperative recurrence in Crohn's disease

Background/Aims: Surgery for Crohn's disease is frequently followed by symp tomatic recurrence, which in up to 40% requires reoperation within 6 years. Whilst there is evidence that postoperative medical prophylaxis can be eff icient, the results of clinical trials are inconsistent regarding the achie ved benefit for the patient. Several parameters have been claimed to indica te an increased intrinsic risk of early surgical recurrence. Methodology: Patient charts of 287 patients who had undergone abdominal sur gery for Crohn's disease were reviewed. Mean follow-up was 4.4 years. Recur rence-free intervals were calculated by the Kaplan-Meier method. A uni- and multivariate analysis was conducted to assess the impact of possible indic ators of the need of repeated surgery. Results: Patients with fistulizing type of symptoms, extraintestinal manife stations, corticosteroid treatment or male gender experienced significantly earlier reoperation. Recurrent disease, histologic evidence of inflamed re section margins, patient's age at the time of primary diagnosis and operati on and the presence of epitheloid granulomas did not show significant influ ence on recurrence-free intervals. Conclusions: We conclude that the natural course of disease after intestina l resection in patients with one or more of these risk factors tends toward s earlier recurrence requiring surgical intervention. The risk factors iden tified in this trial may be useful for patient stratification for randomize d trials on the efficacy of medical prophylaxis.