Postoperative Recurrence of Crohn’s Disease–Is the Early Use of Postoperative Immunomodulators Able to Modify Prognosis?

Abstract

Introduction: Many patients with Crohn’s Disease (CD) require surgical resection during their lifetime. Nevertheless, postoperative recurrence (POR) is common. Risk factors for POR are still yet to be completely established, but some prognostic factors have already been widely recognized. Patients that undergo early postoperative immunomodulators (EPI) (azathioprine or biological therapy) seem to have a lower risk of recurrence. We aimed at assessing whether or not EPI is effective in preventing POR and at the same time validating traditional and new risk factors for POR. Methods: A single-center retrospective cohort study was performed. Review of clinical, demographic and histopathological characteristics of patients undergoing ileocolonic resection for CD between 2015 and 2020 was performed. EPI was defined as the restarting or introduction of azathioprine or biologics within 8 weeks after surgery. Presence of recurrence was defined as Rutgeerts score ≥ i2. Results: Sixty-five patients were included. The median age at diagnosis was 25 years (inter-quartile range 20–33 years). POR was present in 44.6% of patients, and the median time from surgery to recurrence was 2 years. EPI was the therapeutic option in 36 patients (55.4%). Univariate analysis identified as predictors of POR within 2 years: the behavior of the disease and not taking azathioprine or biologics prior to the surgery. Moreover, univariate analysis identified as predictors of time to POR: behavior of disease, less than 5 years between diagnosis and surgery and the absence of immunomodulatory therapy prior to the surgery. Multivariable analysis revealed that EPI, after adjusting for other predictors, was not associated with a reduction in POR. Conclusions: EPI may not have a protective effect against recurrence. The strength of prognostic factors for POR may not be modified by EPI.

Keywords

• Crohn Disease
• postoperative recurrence
• retrospective studies
• inflammatory bowel disease
• ileocolonic resection