Re-resection Rates and Disease Recurrence in Crohn’s Disease: A Population-based Study Using Individual-level Patient Data

• Published in: Journal of Crohn's and colitis 2024-10, Vol.18 (10), p.1631-1643
• Main Authors: Poulsen, Anja, Rasmussen, Julie, Wewer, Mads Damsgaard, Holm Hansen, Esben, Nordestgaard, Rie Louise Møller, Søe Riis Jespersen, Hans, Christiansen, Dagmar, Surnacheva, Elena, Lin, Viviane Annabelle, Aydemir, Nurcan, Verlo, Kari Anne, Rønne Pachler, Frederik, Ovesen, Pernille Dige, Fuglsang, Kristian Asp, Brandt, Christopher Filtenborg, Sørensen, Lars Tue, Krarup, Peter-Martin, Gögenur, Ismail, Burisch, Johan, Seidelin, Jakob B
• Format: Article
• Language: English
• ISSN: 1873-9946; 1876-4479; 1876-4479
• DOI: 10.1093/ecco-jcc/jjae070

Abstract Background and Aims Despite advances in the medical treatment of Crohn’s disease [CD], many patients will still need bowel resections and face the subsequent risk of recurrence and re-resection. We describe contemporary re-resection rates and identify disease-modifying factors and risk factors for re-resection. Methods We conducted a retrospective, population-based, individual patient-level data cohort study covering 47.4% of the Danish population, including all CD patients who underwent a primary resection between 2010 and 2020. Results Among 631 primary resected patients, 24.5% underwent a second resection, and 5.3% a third. Re-resection rates after 1, 5, and 10 years were 12.6%, 22.4%, and 32.2%, respectively. Reasons for additional resections were mainly disease activity [57%] and stoma reversal [40%]. Disease activity-driven re-resection rates after 1, 5, and 10 years were 3.6%, 10.1%, and 14.1%, respectively. Most stoma reversals occurred within 1 year [80%]. The median time to recurrence was 11.0 months. Biologics started within 1 year of the first resection revealed protective effect against re-resection for stenotic and penetrating phenotypes. Prophylactic biologic therapy at primary ileocaecal resection reduced disease recurrence and re-resection risk (hazard ratio [HR] 0.58, 95% confidence interval [CI] [0.34-0.99], p = 0.047). Risk factors for re-resection were location of resected bowel segments at the primary resection, disease location, disease behaviour, smoking, and perianal disease. Conclusion Re-resection rates, categorised by disease activity, are lower than those reported in other studies and are closely associated with disease phenotype and localisation. Biologic therapy may be disease-modifying for certain subgroups when initiated within 1 year of resection. Graphical Abstract Graphical Abstract