Timing Of Surgery On Postoperative Complications And Recurrence After Bowel Resection For Crohn’s Disease

There are two major problems in the surgical treatment for Crohn’s disease. One is high rate of postoperative complications and the other is postoperative recurrence.Our study was aimed to determine whether perioperative disease activity and nutrition state were associated with recurrence and complications after bowel resection for Crohn’s disease.The study was divided in two parts, the first part included two retrospective researches and the second part was a prospective study.Part1(1) Impact of perioperative malnutrition on postoperative complications and recurrence after bowel resection for Crohn’s diseaseObjective:The present retrospective study was aimed to determine whether perioperative malnutrition was associated with postoperative recurrence and complications after bowel resection for Crohn’s disease. Methods:Patients undergoing bowel resection for CD at the Jinling hospital of Nanjing University School of Medicine from2002to2011were retrosperctively analyzed. Postoperative recurrence and complications in patients without malnutrition was compared with those with undernutrition.Results:Of the94patients,41without malnutrition and53were malnourished. Clinical and endoscopic recurrence were recorded and compared respectively. The difference about postoperative recurrence between the two groups was insignificant. But the rates of postoperative complications in patients without malnutrition were significantly lower than those with malnutrition (P<0.001).Conclusions:Although nutritional status showed no significant effects on postoperative recurrence, patients without malnutrition at the time of surgery represented decreased complications after operation. Part1(2) Impact of disease activity on postoperative recurrence and complications after bowel resection for Crohn’s diseaseObjective:Our retrospective study was aimed to determine whether the perioperative disease activity is associated with recurrence and complications after bowel resection for Crohn’s disease.Method:Clinical data of patients underwent bowel resection for CD at the Jinling hospital of Nanjing University School of Medicine from2002to2011was retrospectively analyzed. Postoperative recurrence and complications in patients with active disease were compared with those in remission.Results:A total of90patients underwent bowel resection for CD, active disease were seen in43patients at the time of surgery, while the rest47patients were in remission. The postoperative cumulative endoscopic recurrence rate was8.5%at1year,27.7%at2years and44.7%at3years in the patients with remission, and was27.9%at1year,37.2%at2years and53.5%at3years in patients with active disease. Data indicated the endoscopic recurrence was statistically significant in the first year after surgery (Log-rank P=0.032). Additionally, the postoperative complication rate in patients in remission was significantly lower than those with active disease (P<0.001).Conclusion:Patients with active disease at the time of surgery were encountered with early postoperative recurrence and increased complications after intestinal resection for CD. Part2Impact of disease activity and nutrition on postoperative recurrence and complications after bowel resection for Crohn’s diseaseObjective:Our prospective study was aimed to determine whether the perioperative disease activity and nutrition were associated with recurrence and complications after bowel resection for Crohn’s disease.Method:Clinical data of patients undergoing bowel resection for CD at the Jinling hospital of Nanjing University School of Medicine from2011to2012was analyzed. Patients were divided into two groups, Group I: preoperative inflammatory parameters were normal; Group N: preoperative nutrition state was normal. Postoperative recurrence and complications were compared in the two groups.Results:There were20patients in Group I and22patients in Group N, the two groups had no statistical differences in postoperative recurrence and complications. Group I had a lower serious complications(anastomotic fistula, intraperitoneal abscess) than Group N, the difference was statistically significant (0.0%,0/20vs5/22,22.7%;P=0.0492)Conclusion:Patients with active disease at the time of surgery increased serious complications after intestinal resection for CD.