Risk Factors for Endoscopic Recurrence After Surgical Resection in Patients with Crohn's Disease Treated with Anti-TNFα Postoperatively: A Study of 42 Cases

Aims This study aimed to identify and analyze the risk factors associated with endoscopic recurrence of Crohn's disease (CD) following surgical resection. Postoperative recurrence remains a significant challenge in the management of CD, despite the use of postoperative anti-TNF therapy. Identifying factors contributing to this recurrence is essential for optimizing care and improving long-term prognosis.

Methods The study included a cohort of 42 consecutive patients with Crohn's disease, all of whom underwent surgical resection due to complications related to intestinal stenosis. All patients received anti-TNF-α treatment after surgery. Among these patients, 22 were treated with Adalimumab, while 20 received Infliximab. Endoscopic recurrence was defined as the presence of endoscopic lesions classified as i2a or higher, according to the Rutgeerts classification, one year after resection. Clinical, therapeutic, and epidemiological parameters were studied using univariate analysis to determine factors correlated with endoscopic recurrence.

Results Of the 42 patients included, 23 (55%) experienced endoscopic recurrence, while 19 (45%) showed no signs of recurrence. Univariate analysis revealed several factors significantly associated with an increased risk of endoscopic recurrence. Notably, a delay of more than six months before initiating anti-TNF treatment after surgical resection was observed in 65% of patients who relapsed compared to 26% of those without recurrence. Additionally, a delay of more than 50 months between the initial diagnosis of Crohn's disease and surgical resection was noted (57% vs. 21%). The use of Adalimumab was more frequently associated with endoscopic recurrence (70% vs. 32%) compared to Infliximab (30% vs. 68%). These results suggest that timely and appropriate therapeutic interventions could play a crucial role in preventing postoperative recurrence.

Conclusions Endoscopic recurrence after surgical resection for Crohn's disease remains common, affecting more than half of the patients studied. Key predictive factors for recurrence include a delay of over six months between initiating anti-TNF treatment and surgical resection, an interval greater than 50 months between the diagnosis of CD and surgical resection, and the use of Adalimumab rather than Infliximab. These findings highlight the importance of rigorous follow-up and prompt therapeutic management after surgery to improve long-term clinical outcomes. Further studies, including multivariate analyses and controlled clinical trials, are needed to confirm these observations and refine postoperative management strategies for Crohn's disease.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025