Risk factors for postoperative recurrence after primary bowel resection in patients with Crohn's disease

AIM To evaluate the risk factors for postoperative recurrence after primary bowel resection in a cohort of Korean Crohn's disease (CD) patients. METHODS This study included 260 patients with no history of previous bowel surgery who underwent primary surgery for CD between January 2000 and December 2010 at Asan Medical Center (Seoul, South Korea). The median follow-up period was 101 mo. RESULTS During the follow-up period, 66 patients (25.4%) underwent a second operation for disease recurrence. At 1, 5 and 10 years after the first operation, the cumulative rate of surgical recurrence was 1.1%, 8.3% and 35.9% and clinical recurrence occurred in 1.2%, 23.6% and 68.1%, respectively. In multivariate analysis, undergoing an emergency operation was a significant risk factor for surgical recurrence-free survival (SRFS) [HR = 2.431, 95% CI: 1.394-4.240, P = 0.002], as were the presence of perianal disease after the first operation (HR = 1.715, 95% CI: 1.005-2.926, P = 0.048) and history of smoking (HR = 1.798, 95% CI: 1.088-2.969, P = 0.022). The postoperative use of antitumor necrosis factor (TNF) agents reduced SRFS risk (HR = 0.521, 95% CI: 0.300-0.904, P = 0.02). CONCLUSION History of smoking, postoperative perianal disease and undergoing an emergency operation were independent risk factors for surgical recurrence. Using anti-TNF agents may reduce surgical recurrence.