Rate of Reoperation Decreased Significantly After Year 2002 in Patients With Crohn's Disease

Takahide Shinagawa; Keisuke Hata; Hiroki Ikeuchi; Kouhei Fukushima; Kitaro Futami; Akira Sugita; Motoi Uchino; Kazuhiro Watanabe; Daijiro Higashi; Hideaki Kimura; Toshimitsu Araki; Tsunekazu Mizushima; Michio Itabashi; Takeshi Ueda; Kazutaka Koganei; Koji Oba; Soichiro Ishihara; Yasuo Suzuki

doi:10.1016/j.cgh.2019.07.025

Rate of Reoperation Decreased Significantly After Year 2002 in Patients With Crohn's Disease

Clin Gastroenterol Hepatol. 2020 Apr;18(4):898-907.e5. doi: 10.1016/j.cgh.2019.07.025. Epub 2019 Jul 20.

Authors

Takahide Shinagawa¹, Keisuke Hata², Hiroki Ikeuchi³, Kouhei Fukushima⁴, Kitaro Futami⁵, Akira Sugita⁶, Motoi Uchino³, Kazuhiro Watanabe⁷, Daijiro Higashi⁵, Hideaki Kimura⁸, Toshimitsu Araki⁹, Tsunekazu Mizushima¹⁰, Michio Itabashi¹¹, Takeshi Ueda¹², Kazutaka Koganei⁶, Koji Oba¹³, Soichiro Ishihara¹, Yasuo Suzuki¹⁴

Affiliations

¹ Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan.
² Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan. Electronic address: khata-tky@umin.ac.jp.
³ Department of Inflammatory Bowel Disease, Division of Surgery, Hyogo College of Medicine, Nishinomiya, Japan.
⁴ Division of Surgical and Molecular Pathophysiology, Graduate School of Medicine, Tohoku University, Sendai, Japan; Laboratory of Gastrointestinal Reconstruction, Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan.
⁵ Department of Surgery, Fukuoka University Chikushi Hospital, Chikushino, Japan.
⁶ Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, Yokohama, Japan.
⁷ Department of Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan.
⁸ Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan.
⁹ Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan.
¹⁰ Department of Gastroenterological Surgery, Therapeutics for Inflammatory Bowel Diseases, Osaka University Graduate School of Medicine, Osaka, Japan.
¹¹ Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
¹² Department of Surgery, Nara Medical University, Kashihara, Japan.
¹³ Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Nishinomiya, Japan.
¹⁴ Department of Internal Medicine, Sakura Medical Centre, Toho University, Tokyo, Japan.

PMID: 31336198
DOI: 10.1016/j.cgh.2019.07.025

Abstract

Background & aims: Patients with Crohn's disease (CD) can require multiple intestinal surgeries. We examined time trends and risk factors for reoperation in patients with CD who underwent intestinal surgery, focusing on the effects of postoperative medical treatments.

Methods: We performed a retrospective analysis of 1871 patients with CD who underwent initial intestinal resection at 10 tertiary care institutions in Japan, with an initial surgical date after May 1982. We collected data on the background characteristics of all patients, including Montreal Classification, smoking status, and medical therapy after surgery (tumor necrosis factor antagonists [anti-TNF] agents or immunomodulators). The primary outcome was requirement for first reoperation. Rate of reoperation was estimated using the Kaplan-Meier method, and risk factors for reoperation were identified using the Cox regression model.

Results: The overall cumulative 5- and 10-year reoperation rates were 23.4% and 48.0%, respectively. Multivariable analysis showed that patients who underwent the initial surgery after May 2002 had a significantly lower rate of reoperation than patients who underwent surgery before April 2002 (hazard ratio [HR], 0.72; 95% CI, 0.61-0.86). Preoperative smoking (HR, 1.40; 95% CI, 1.18-1.68), perianal disease (HR, 1.50; 95% CI, 1.27-1.77), and ileocolic type of CD (HR, 1.42; 95% CI, 1.20-1.69) were significant risk factors for reoperation. Postoperative use of immunomodulators (HR, 0.60; 95% CI, 0.44-0.81) and anti-TNF therapy (HR, 0.71; 95% CI, 0.57-0.88) significantly reduced the risk. Anti-TNF was effective in the bionaive subgroup.

Conclusions: The rate of reoperation in patients with CD significantly decreased after May 2002. Postoperative use of anti-TNF agents might reduce the reoperation rate for bionaive patients with CD.

Keywords: Environmental Factor; IBD; Inflammatory Bowel Disease; Outcomes.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Crohn Disease* / drug therapy
Crohn Disease* / surgery
Digestive System Surgical Procedures*
Humans
Reoperation
Retrospective Studies
Risk Factors
Tumor Necrosis Factor Inhibitors

Substances

Tumor Necrosis Factor Inhibitors