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Long-term Outcomes and Risk Factors for Reoperation After Surgical Treatment for Gastrointestinal Crohn Disease According to Anti-tumor Necrosis Factor-α Antibody Use: 35 Years of Experience at a Single Institute in Korea

대한대장항문학회지 2015년 31권 4호 p.144 ~ 152
 ( Lee Sang-Mok ) - Seoul National University College of Medicine Department of Surgery

 ( Han Eon-Chul ) - Seoul National University College of Medicine Department of Surgery
 ( Ryoo Seung-Bum ) - Seoul National University College of Medicine Department of Surgery
 ( Oh Heung-Kwon ) - Seoul National University College of Medicine Seoul National University Bundang Hospital Department of Surgery
 ( Choe Eun-Kyung ) - Seoul National University Hospital Healthcare System Gangnam Center
 ( Moon Sang-Hui ) - Seoul National University College of Medicine Department of Surgery
 ( Kim Joo-Sung ) - Seoul National University College of Medicine Department of Internal Medicine
 ( Jung Hyun-Chae ) - Seoul National University College of Medicine Department of Internal Medicine
 ( Park Kyu-Joo ) - Seoul National University College of Medicine Department of Surgery

Abstract


Purpose
Crohn disease is characterized by high rates of recurrence and reoperations. However, few studies have investigated long-term surgical outcomes in Asian populations. We investigated risk factors for reoperation, particularly those associated with anti-tumor necrosis factor-α (anti-TNF-α) antibody use, and long-term follow-up results.

Methods
We reviewed the records of 148 patients (100 males and 48 females) who underwent surgery for gastrointestinal Crohn disease and retrospectively analyzed long-term outcomes and risk factors.

Results
The mean age at diagnosis was 28.8 years. Thirty-eight patients (25.7%) received monoclonal antibody treatment before reoperation. A small bowel and colon resection was most commonly performed (83 patients, 56.1%). The median follow-up was 149 months, during which 47 patients underwent reoperation. The median interval between the primary and the secondary surgeries was 65 months, with accumulated reoperation rates of 16.5%, 31.8%, and 57.2% after 5, 10, and 15 years, respectively. Obstruction was the most common indication for reoperation (37 patients, 25.0%). In a multivariable analysis, age <17 years at diagnosis (A1) (odds ratio [OR], 2.20; P = 0.023), penetrating behavior (B3) (OR, 4.39; P < 0.001), and no azathioprine use (OR, 2.87; P = 0.003) were associated with reoperation. Anti-TNF-α antibody use did not affect the reoperation rate (P = 0.767).

Conclusion
We showed a high reoperation rate regardless of treatment with anti-TNF-α antibody, which indicates that recurrent surgery is still needed to cure patients with gastrointestinal Crohn diseases. Younger age at primary operation, penetrating behavior, and no azathioprine use were significant factors associated with reoperation for gastrointestinal Crohn disease.

키워드

Crohn disease; Reoperation; Azathioprine; Infliximab
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