Recurrence after colectomy in Crohn's colitis

PURPOSE: Previous studies on recurrence and reoperation after colectomy in Crohn's colitis have been based on heterogeneous groups of patients, and di vergent findings may be explained by referral biases and small numbers of p atients. The aim of this study was to account for recurrence rates, present risk factors for recurrence after primary colectomy, and account for the u ltimate risk of having a stoma after colectomy with ileorectal anastomosis in patients with Crohn's colitis. METHODS: Data on the primary resection, p ostoperative recurrence, influence of concomitant risk factors, frequency o f stoma operations and proctectomy were evaluated retrospectively using mul tivariate analysis in a population-based cohort of 833 patients with Crohn' s colitis. RESULTS: The cumulative 10-year risk of a symptomatic recurrence was 58 percent (95 percent confidence interval, 53-63 percent) and 47 perc ent (95 percent confidence interval, 42-52 percent), respectively, after co lectomy with ileorectal anastomosis and segmental colonic resection. in col ectomy with ileostomy, lower rates were found with respectively 24 percent (95 percent confidence interval, 18-30 percent) and 37 percent (95 percent confidence interval, 32-43 percent) after subtotal colectomy and proctocole ctomy with ileostomy. The multivariate analysis showed that perianal diseas e, ileorectal anastomosis, and segmental resection were independent risk fa ctors for postoperative recurrence. In 76 percent of patients with ileorect al anastomosis, a stoma-free function could be retained during a median fol low-up of 12.5 years. CONCLUSION: Colectomy with ileorectal anastomosis or segmental resection is a feasible option in the surgical treatment of Crohn 's colitis, although anastomoses, in addition to perianal dis ease, carry a n increased risk of recurrent disease.