Gut and Liver https://doi.org/10.5009/gnl19085 Risk Factors for Postoperative Recurrence in Korean Patients with Crohn's Disease
Author Information
Sung Bae Kim1 , Jae Hee Cheon1 , Jae Jun Park1 , Eun Soo Kim2 , Seong Woo Jeon2 , Sung-Ae Jung3 , Dong Il Park4 , Chang Kyun Lee5 , Jong Pil Im6 , You Sun Kim7 , Hyun Soo Kim8 , Jun Lee9 , Chang Soo Eun10 , Jeong Mi Lee11 , Byung Ik Jang12 , and Geom Seog Seo13
1Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, 2Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, 3Department of Internal Medicine, Ewha Womans University School of Medicine, 4Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 5Center for Crohn's and Colitis, Department of Gastroenterology, Kyung Hee University College of Medicine, 6Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 7Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, 8Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, 9Department of Internal Medicine, Chosun University College of Medicine, Gwangju, 10Department of Internal Medicine, Hanyang University Guri Hospital, Guri, 11Department of Public Health, Wonkwang University Graduate School, Iksan, 12Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, and 13Department of Internal Medicine, Digestive Disease Research Institute, Wonkwang University College of Medicine, Iksan, Korea

Geom Seog Seoa and Byung Ik Jangb
aDepartment of Internal Medicine, Digestive Disease Research Institute, Wonkwang University College of Medicine, 460 Iksan-daero, Iksan 54538, Korea
Tel: +82-63-859-2565, Fax: +82-63-855-2025, E-mail: medsgs@wonkwang.ac.kr
bDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu 42415, Korea
Tel: +82-53-620-3831, Fax: +82-53-654-8386, E-mail: jbi@med.yu.ac.kr
© The Korean Society of Gastroenterology, the Korean Society of Gastrointestinal Endoscopy, the Korean Society of Neurogastroenterology and Motility, Korean College of Helicobacter and Upper Gastrointestinal Research, Korean Association the Study of Intestinal Diseases, the Korean Association for the Study of the Liver, Korean Pancreatobiliary Association, and Korean Society of Gastrointestinal Cancer. All rights reserved.

Abstract
Background/Aims: A considerable number of patients with Crohn's disease still need intestinal resection surgery. Postoperative recurrence is an important issue in Crohn's disease management, including the selection of high-risk patients. Eastern Asian patients showed several differences from Caucasian patients. Therefore, we investigated the postoperative surgical recurrence outcome and identified risk factors in Korean patients. Methods: Clinical data of 372 patients with Crohn's disease who underwent first intestinal resection between January 2004 and August 2014 at 14 hospitals in Korea were retrospectively reviewed. Results: Over the follow-up period, 50 patients (17.1%) showed surgical recurrence. The cumulative surgical recurrence rate was 6.5% at 1 year and 15.4% at 7 years. Age under 16 (p=0.011; hazard ratio [HR], 5.136; 95% confidence interval [CI], 1.576 to 16.731), colonic involvement (p=0.023; HR , 2.011; 95% CI, 1.102 to 3.670), and the presence of perianal disease at surgery (p=0.008; HR, 2.239; 95% CI, 1.236 to 4.059) were independent risk factors associated with surgical recurrence. Postoperative thiopurine treatment (p=0.002; HR, 0.393; 95% CI, 0.218 to 0.710) was a protective factor for surgical recurrence. Conclusions: Among the disease characteristics at surgery, younger age, colonic location, and perianal lesions were independent risk factors for surgical recurrence. Postoperative thiopurine treatment significantly reduced the incidence of surgical recurrence.
Keywords: Crohn disease; Recurrence; Surgery; Risk factors; Thiopurine
Abstract
Background/Aims: A considerable number of patients with Crohn's disease still need intestinal resection surgery. Postoperative recurrence is an important issue in Crohn's disease management, including the selection of high-risk patients. Eastern Asian patients showed several differences from Caucasian patients. Therefore, we investigated the postoperative surgical recurrence outcome and identified risk factors in Korean patients. Methods: Clinical data of 372 patients with Crohn's disease who underwent first intestinal resection between January 2004 and August 2014 at 14 hospitals in Korea were retrospectively reviewed. Results: Over the follow-up period, 50 patients (17.1%) showed surgical recurrence. The cumulative surgical recurrence rate was 6.5% at 1 year and 15.4% at 7 years. Age under 16 (p=0.011; hazard ratio [HR], 5.136; 95% confidence interval [CI], 1.576 to 16.731), colonic involvement (p=0.023; HR , 2.011; 95% CI, 1.102 to 3.670), and the presence of perianal disease at surgery (p=0.008; HR, 2.239; 95% CI, 1.236 to 4.059) were independent risk factors associated with surgical recurrence. Postoperative thiopurine treatment (p=0.002; HR, 0.393; 95% CI, 0.218 to 0.710) was a protective factor for surgical recurrence. Conclusions: Among the disease characteristics at surgery, younger age, colonic location, and perianal lesions were independent risk factors for surgical recurrence. Postoperative thiopurine treatment significantly reduced the incidence of surgical recurrence.
Keywords: Crohn disease; Recurrence; Surgery; Risk factors; Thiopurine
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