Risk factors for symptomatic anastomotic post-operative recurrence following ileo-colic resection in Crohn's disease.

Navaratne, Lalin; Hurndall, Katherine-Helen; Richardson, Daniel M; Stephenson, Robert; Power, Niall; Gillott, Holly; Ruiz Sánchez, Susana; Khodatars, Kuresh; Chan, Christopher Lh

AIM Crohn's disease is a chronic inflammatory bowel disease characterised by alternating periods of exacerbation and remission. Surgical resection is not curative and post-operative recurrence (POR) remains a challenge in these patients. The aim of this study was to identify clinical variables that influence the risk of symptomatic anastomotic POR in patients with ileocolonic Crohn's disease. METHODS Retrospective study of Crohn's disease patients who had undergone ileo-colic resection between January 2014 and December 2018 was performed. For each patient, data was extracted to include demographic information, Crohn's disease clinical setting, pre-operative radiological data, operative and histological data, pre- and post-operative medication history and post-operative clinical course including recurrence of disease. Symptomatic anastomotic POR was defined as symptoms of Crohn's disease in the presence of confirmed anastomotic POR (endoscopic and/or radiological POR). RESULTS For the study period, 104 patients were eligible and included for analysis. The cumulative probability of symptomatic anastomotic POR was 14%, 30%, 42%, 50% and 50% at 1, 2, 3, 4, and 5 years, respectively. Two clinical variables on multivariate analysis were associated with increased risk of symptomatic anastomotic POR and included, age <17 years at diagnosis (HR 2.17, p=0.019) and gastrointestinal involvement (extent) >30cm (HR 1.85, p=0.048). CONCLUSION This study describes the natural history of POR after ileo-colic resection for Crohn's disease, as defined by endoscopic, radiological, and clinical outcomes. Age <17 years at diagnosis and gastrointestinal involvement (extent) >30cm were independent risk factors for symptomatic anastomotic post-operative recurrence.