| Background and aims:Crohn’s disease(CD)is a chronic immune-mediated inflammatory condition of gastrointestinal tract with a waxing and waning,progressive clinical course.In the era of biologic agents,surgical technology has developed a lot,and the rate of CD related sugery has dramatically decreased.However,46.6%CD patients still required surgery within 10 years after diagnosis,and about 20-40%CD patients experienced postoperative recurrence(POR)within 1 year.Moreover,the predictors of POR are still under debate.Postoperative complicates frequently occurred associated with long-term consumption and inflammation in CD patients.The study aimed at analysing the status of surgical development in CD patients,the long-term rate of POR in non-treatment group and predictive risk factors associated with POR and postoperative complications.Methods:In this retrospective study,118 patients were included from Crohn’s patients with intestinal resection from January 2003 to April 2016.Comparision of rates was tested using Chi square or Fisher’s exact test.We used log-rank test and multivatiate Cox regression to evaluate univariate and multivariate risk factors for POR respectively.P value less than 0.05 was considered to be statistically significant.Outcomes:1.Baseline characteristics1.1 Baseline clinical dataA total of 118 patients underwent CD-related intestinal resection,28.8%(34/118)were female,the median age of diagnosis was 36.5(17.0)years old.49.2%(58/118)were divided into no-treatment group with 50.2%(60/118)into treatment group.1.2 The status of surgical development:(1)Less patients underwent laparoscopic operations from 2011 to 2016 than that from 2003 to 2010(p=0.001);(2)More patients underwent stapled side-to-side anastomosis from 2011 to 2016 than that from 2003 to 2010(p<0.0001);2.POR 2.1 The rate of PORThe median follow-up period was 14.3(27.0)months,the 1-year,3-year,5-year and 9-year of accumulated POR rates in the overall cohort were 43.3%,63.7%,74.1%and 83.8%,respectively.In the non-treatment group,the 1-year,3-year,5-year and 9-year accumulated POR rates were 48.1%,66.4%,77.1%and 87.7%,respectively.2.2 Univariate analysis with Log-rank testExtra-intestinal manifestation,neutrophilic granulocyte percentage≥75%,C-reactive protein(CRP)≥10mg/L and treatment with AZA before surgery were statistically associated with POR(p<0.05).2.3 Multi-variate analysis with Cox regressionprophylactics significantly lowered the risk of POR(p<0.05),neutrophilic granulocyte percentage≥75%and hemoglobin level<90g/L significantly increased the risk of POR(p<0.05).3.Postoperative complications14.4%CD patients developed intraabdominal septic complications.4.The effect of Infliximab(IFX)+Azathioprine(AZA)on POR20 patients in the IFX+AZA group were followed up for a median period of 23.3(23.6)months.The 1-year,2-year and 3-year accumulated POR rates were 43.2%,58.4%and 58.4%,respectively.29 patients in the AZA group were followed up for a median period of 16.3(22.8)months.The 1-year,2-year and 3-year accumulated POR rates were 42.3%,53.8%and 53.8%,respectively.The differences between the two groups were not statistically significant with a P value of 0.969.5.The effect of thalidomide on POR.3 patients had thalidomide 50-150mg to prevent POR.Three months later,1 patient suffered POR.The other 2 patients were still in postoperative remission until the end of follow-up.Conclusions:Stapled side-to side anastomosis has become the main surgical strategy in CD patiens.The long-term natural course in CD patients after surgery didn’t go well.The high level of neutrophilic granulocyte percentage,low level of hemoglobin and non-prophylactic increased the risk of POR.The efficacy of combination treatment of IFX and AZA was comparable to AZA on POR in CD patients.More studies were required to prove the role of thalidomide in the prevention of POR.Postoperative complications occurred frequently with CD patients,especially intraabdominal septic complications. |
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