Background: Surgery in Crohn disease (CD) is associated with poor prognosis and higher rate of clinical and surgical recurrence. The aim of our study was to compare the characteristics and management of CD patients that have undergo one surgery with patients that have undergo more than one surgery.
Methods: PRACTICROHN was an observational study that included patients aged ≥18 years-old from 26 spanish hospitals who underwent CD-related resection with ileocolonic or ileorectal anastomosis between January 2007 and December 2010. Patient data were retrospectively collected from medical records. Categorical variables were compared with the χ2 test or Fisher's exact test. Kaplan-Meier method was used to assess time to clinical recurrence and a log-rank test to obtain statistical significance.
Results: 314 patients were analyzed, 262 (83%)were included in the first surgery (50% males) and 52 (16%) referred previous surgeries (36% males). Mean age at diagnosis was similar in the first surgery group (FSG) (33±14 years) vs second surgery group (SSG). Age at index surgery was 39±13 years in FSG vs 43±12 in SSG, p=0.021. Smoking habit was higher in FSG vs SSG (41% vs 34%, p=0.47). Montreal classification in the two groups were similar except for behavior, with higher proportion of patients with B1 in FSG vs SSG (124 (48%) vs 13 (28%)) and higher proportion of B2 and B3 in SSG (74 (29%) B2 in FSG vs 21 (46%) in SSG and 57 (22%) B3 in FSG vs 12 (26%) in SSG), p=0.027. Regarding treatment, 33 (13%) patients in the FSG received steroids previous to surgery vs 13 (27%) patients in the SSG. p=0.029. No difference in IMM and biological treatment previous to surgery was found between the two groups. After surgery, a higher proportion of patients received prophylactic treatment with IMM in the SSG compared with FSG p=0.012. No difference in the rate of colonoscopies performed during first year after surgery was found between the two groups as well as in the findings at the colonoscopies. Hospitalizations and postoperative complications were also similar. There was no diference in clinical recurrence in SSG in patients receiving or not prophylaxis (p=0.5) whereas in FSG clinical recurrence-free survival was greater in patients with prophylactic treatment (p=0.03) (Fig. 1).
Conclusions: In our sample, although patients in SSG were less smokers and received more prophylaxis with IMM and similar post surgery follow-up, they presented more clinical recurrence. This confirms that undergoing a second surgery is a main factor of poor prognosis.