Recurrence and impact of postoperative prophylaxis in laparoscopically treated primary ileocolic crohn disease

Kishore Malireddy, David Larson, William J. Sandborn, Edward Vincent Loftus, Jr, William Alvis Faubion, Darrell S. Pardi, Rui Qin, Rachel E. Gullerud, Robert R. Cima, Bruce Wolff, Eric Dozois

Research output: Contribution to journalArticle

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Abstract

Objectives: To define risk factors for recurrence and to determine whether postoperative prophylaxis would influence time to recurrence after primary laparoscopic ileocolectomy for Crohn disease. Design: Retrospective record review. Setting: Tertiary academic medical center. Patients: All patients who underwent primary laparoscopic ileocolectomy for terminal ileal Crohn disease between April 28, 1994, and August 3, 2006, at the Mayo Clinic, Rochester, Minnesota. Main Outcome Measures: All patients were reviewed for follow-up, recurrence, risk factors for recurrence, and use of postoperative immunosuppressive prophylaxis. Results: One hundred nine patients were identified, of whom89 were followed up postoperatively at Mayo Clinic with a median follow-up of 3.5 years (range, 1.8 months to 11.9 years). Recurrence was discovered in 54 patients (61%) at a median of 13.1 months (range, 1.3 months to 8.7 years). Forty-four patients (49%) received postoperative immunosuppressive prophylaxis (37 [42%] received azathioprine, 8 [9%] received 6-mercaptopurine, and 3 [3%] received infliximab). In a multivariate model of various risk factors for recurrence, presence of granulomas was the only significant predictor of recurrence (P=.01). The 2-year cumulative recurrence rates in the prophylaxis and nonprophylaxis groups were 37.5% and 52.6%, respectively (log-rank test, P=.87). Conclusions: Recurrence occurred in more than half of the patients with Crohn disease after primary laparoscopic ileocolectomy. In this highly selected patient population, use of immunosuppressive prophylaxis was not associated with a delay in recurrence. Presence of granulomas was the only significant predictor of recurrence. These findings should be further explored in larger and less selected patient populations.

Original languageEnglish (US)
Pages (from-to)42-47
Number of pages6
JournalArchives of Surgery
Volume145
Issue number1
DOIs
StatePublished - Jan 2010

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Crohn Disease
Recurrence
Immunosuppressive Agents
Granuloma
Ileal Diseases
6-Mercaptopurine
Azathioprine
Population
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Surgery

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Recurrence and impact of postoperative prophylaxis in laparoscopically treated primary ileocolic crohn disease. / Malireddy, Kishore; Larson, David; Sandborn, William J.; Loftus, Jr, Edward Vincent; Faubion, William Alvis; Pardi, Darrell S.; Qin, Rui; Gullerud, Rachel E.; Cima, Robert R.; Wolff, Bruce; Dozois, Eric.

In: Archives of Surgery, Vol. 145, No. 1, 01.2010, p. 42-47.

Research output: Contribution to journalArticle

Malireddy, Kishore ; Larson, David ; Sandborn, William J. ; Loftus, Jr, Edward Vincent ; Faubion, William Alvis ; Pardi, Darrell S. ; Qin, Rui ; Gullerud, Rachel E. ; Cima, Robert R. ; Wolff, Bruce ; Dozois, Eric. / Recurrence and impact of postoperative prophylaxis in laparoscopically treated primary ileocolic crohn disease. In: Archives of Surgery. 2010 ; Vol. 145, No. 1. pp. 42-47.
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abstract = "Objectives: To define risk factors for recurrence and to determine whether postoperative prophylaxis would influence time to recurrence after primary laparoscopic ileocolectomy for Crohn disease. Design: Retrospective record review. Setting: Tertiary academic medical center. Patients: All patients who underwent primary laparoscopic ileocolectomy for terminal ileal Crohn disease between April 28, 1994, and August 3, 2006, at the Mayo Clinic, Rochester, Minnesota. Main Outcome Measures: All patients were reviewed for follow-up, recurrence, risk factors for recurrence, and use of postoperative immunosuppressive prophylaxis. Results: One hundred nine patients were identified, of whom89 were followed up postoperatively at Mayo Clinic with a median follow-up of 3.5 years (range, 1.8 months to 11.9 years). Recurrence was discovered in 54 patients (61{\%}) at a median of 13.1 months (range, 1.3 months to 8.7 years). Forty-four patients (49{\%}) received postoperative immunosuppressive prophylaxis (37 [42{\%}] received azathioprine, 8 [9{\%}] received 6-mercaptopurine, and 3 [3{\%}] received infliximab). In a multivariate model of various risk factors for recurrence, presence of granulomas was the only significant predictor of recurrence (P=.01). The 2-year cumulative recurrence rates in the prophylaxis and nonprophylaxis groups were 37.5{\%} and 52.6{\%}, respectively (log-rank test, P=.87). Conclusions: Recurrence occurred in more than half of the patients with Crohn disease after primary laparoscopic ileocolectomy. In this highly selected patient population, use of immunosuppressive prophylaxis was not associated with a delay in recurrence. Presence of granulomas was the only significant predictor of recurrence. These findings should be further explored in larger and less selected patient populations.",
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AU - Pardi, Darrell S.

AU - Qin, Rui

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AU - Dozois, Eric

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AB - Objectives: To define risk factors for recurrence and to determine whether postoperative prophylaxis would influence time to recurrence after primary laparoscopic ileocolectomy for Crohn disease. Design: Retrospective record review. Setting: Tertiary academic medical center. Patients: All patients who underwent primary laparoscopic ileocolectomy for terminal ileal Crohn disease between April 28, 1994, and August 3, 2006, at the Mayo Clinic, Rochester, Minnesota. Main Outcome Measures: All patients were reviewed for follow-up, recurrence, risk factors for recurrence, and use of postoperative immunosuppressive prophylaxis. Results: One hundred nine patients were identified, of whom89 were followed up postoperatively at Mayo Clinic with a median follow-up of 3.5 years (range, 1.8 months to 11.9 years). Recurrence was discovered in 54 patients (61%) at a median of 13.1 months (range, 1.3 months to 8.7 years). Forty-four patients (49%) received postoperative immunosuppressive prophylaxis (37 [42%] received azathioprine, 8 [9%] received 6-mercaptopurine, and 3 [3%] received infliximab). In a multivariate model of various risk factors for recurrence, presence of granulomas was the only significant predictor of recurrence (P=.01). The 2-year cumulative recurrence rates in the prophylaxis and nonprophylaxis groups were 37.5% and 52.6%, respectively (log-rank test, P=.87). Conclusions: Recurrence occurred in more than half of the patients with Crohn disease after primary laparoscopic ileocolectomy. In this highly selected patient population, use of immunosuppressive prophylaxis was not associated with a delay in recurrence. Presence of granulomas was the only significant predictor of recurrence. These findings should be further explored in larger and less selected patient populations.

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