Document Detail


Immediate versus tailored prophylaxis to prevent symptomatic recurrences after surgery for ileocecal Crohn's disease?
MedLine Citation:
PMID:  20434748     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Studies have not established the optimal role for prophylaxis after surgery for Crohn's disease. Some suggest treatment should be initiated within the first month after surgery, whereas others advocate targeted treatment after endoscopic recurrence. In the present study, we compared the efficacy of these competing approaches.
METHODS: One hundred and ninety-nine Crohn's disease patients who underwent ileocecectomy between September 1993 and April 2008 were retrospectively divided into 3 groups based on treatment timing: immediate, tailored, and none. Groups were compared for differences in demographics, pathology, and surgical technique (Chi-square, ANOVA). Rate of symptomatic recurrence (Chi-square), and time to symptomatic recurrence were analyzed (log rank, multivariate Cox proportional hazards).
RESULTS: Sixty-nine (34.7%) received immediate prophylaxis, 32 (16.1%) received tailored prophylaxis, and 98 (49.3%) did not receive any prophylaxis. The groups were similar, though patients receiving immediate prophylaxis were younger and less likely to be lost to follow-up. At 5 years, 62 (31.2%) patients had endoscopic, 46 (23.1%) had symptomatic, and 22 (11%) had surgical recurrences. On simple univariate analysis, patients treated in a tailored fashion at time of endoscopic recurrence appeared more likely than patients treated with immediate prophylaxis to have symptomatic recurrence (43.7% vs 28.9%; P = .02), However, when censored for length of follow-up on multivariate analysis, the only enduring predictor of symptomatic recurrence was Charlson Comorbidity Index (P = .048). Timing of treatment, medicine used for immunoprophylaxis, age, history of prior resection, presence of active disease, and type of anastomosis were not predictive of symptomatic recurrence.
CONCLUSION: Patients offered prophylaxis tailored to endoscopic recurrence have a similar time to symptomatic recurrence as those offered prophylaxis immediately. This suggests that a tailored treatment within a strict protocol of preemptive endoscopic surveillance may be reasonable.
Authors:
Liliana Bordeianou; Sharon L Stein; Vanessa P Ho; Abdulmetin Dursun; Bruce E Sands; Joshua R Korzenik; Richard A Hodin
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Surgery     Volume:  149     ISSN:  1532-7361     ISO Abbreviation:  Surgery     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2010-12-14     Completed Date:  2011-01-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0417347     Medline TA:  Surgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  72-8     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2011 Mosby, Inc. All rights reserved.
Affiliation:
Colon and Rectal Surgery Program, Crohn's and Colitis Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA. mbaker3@northshore.org
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Analysis of Variance
Anastomosis, Surgical / methods
Cecum / surgery*
Chi-Square Distribution
Child
Cohort Studies
Crohn Disease / pathology,  prevention & control,  surgery*
Endoscopy / methods
Female
Follow-Up Studies
Humans
Ileum / surgery*
Male
Middle Aged
Multivariate Analysis
Postoperative Complications / prevention & control,  surgery
Primary Prevention / methods
Proportional Hazards Models
Recurrence / prevention & control
Retrospective Studies
Severity of Illness Index
Time Factors
Treatment Outcome
Young Adult

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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