P0317 Risk factors of Post Operative Recurrence in patients with Crohn’s Disease: a multicentre experience of 8 years of follow-up
Authors: Cannatelli R , Ferretti F , Ding N S , Lai M , Carvalhas Gabrielli A M , Monaca F , Carmagnola S , Colombo F , Maconi G 
Published: January 2025

Background

Despite new medical therapy for Crohn’s disease (CD), bowel resection is still performed in 25% of patients within 10 years from the diagnosis of CD.1,2 The aim of our multicentres retrospective study was to evaluete the risk factors of endoscopic post operative recurrence (ePOR) of patients with CD.

Methods

We analyzed the relevance and impact of well-known risk factors for postoperative recurrence, such as clinical, laboratory, endoscopic, and ultrasound findings collected before and within 6 months after surgery, and surgical and histopathological features in a series of consecutive CD patients who underwent bowel resection between 2016 and 2023. All patients were followed up to 6 months, until November 2024. The ePOR of the disease was defined by a Rutgeerts’ score more than i2b. We compared prevalence of risk factors for recurrence in patients with and without ePOR during the follow-up. Logistic regression analysis was also performed to detect risk factors independently correlated with ePOR.

Results

We included 195 patients (male 48.7%, mean age at surgery 42.4±15.1) with a mean of follow-up 4.7±2.7 years (range). ePOR was observed in 83 (58.0%) and surgical recurrence in 19 (11.0%) patients. Pre-operative features (Table 1), correlated with ePOR were younger age at the diagnosis (29.5±14.4, p=0.290), colonic localization (55.4%,p=0.060), structuring behaviour (41.0%,p=0.562), older disease (12.3±10.0,p=0.273) and treatment with &gt;1 biological therapy (44.6%,p=0.040). Patients with ePOR patients were more frequently operated with ileocolonic resection (74.7%,p=0.787) with laparoscopic approach (65.1%,p=0.204), end-to-end anastomosis (87.5%,p=0.255), and had a higher rate of postoperative complications (30.7%,p=0.075). Patients with ePOR showed higher postoperative levels of C-reaction protein (CRP, 6.9±10.0,p=0.050) and faecal calprotectin (FC, 174.2±189.2,p=0.099) such as higher rate of US recurrence at 6 or 12 months were observed (55.6%,p=0.158) and a less frequent prophylactic postoperative therapy (79.4%,p=0.018). In addition, patients who were treated with &gt;2 different biological therapies before surgery (OR 6.12, 95%CI 1.25-29.9,p=0.025) and had post biological therapy (OR 2.85 95%CI 1.31-6.21,p=0.008), mainly because of lack of prophylactic therapy were significant predictors for ePOR. However, these risk factors were not confirmed at the multivariate analysis.

Conclusion

In our experience, patients with increase postoperative levels of CRP or FC have higher probability of having ePOR, and most of them did not start prophylaxis therapy after surgery, but were treated with biologics after surgery due to clinical relapse.

References

1.Bak MTJ, Demers K, Hammoudi N, et al. Systematic review: Patient-related, microbial, surgical, and histopathological risk factors for endoscopic post-operative recurrence in patients with Crohn’s disease. Aliment Pharmacol Ther. 2024;60(3):310-326. doi: 10.1111/apt.18040.

2.Tsai L, Ma C, Dulai PS, et al. Contemporary Risk of Surgery in Patients With Ulcerative Colitis and Crohn’s Disease: A Meta-Analysis of Population-Based Cohorts. Clin Gastroenterol Hepatol. 2021;19(10):2031-2045.e11. doi: 10.1016/j.cgh.2020.10.039.