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.
