Factors associated with surgical resection in patients with Crohn’s disease: long-term evaluation

TL;DR

This study identifies factors like smoking and disease behavior that increase the likelihood of surgery in Crohn’s disease patients over time.

Contribution

The study provides long-term insights into patient characteristics and disease behaviors associated with surgical resection in Crohn’s disease.

Findings

Smoking, longer disease duration, and stenosing/fistulizing behavior are strongly linked to surgical resection in CD patients.

Ileo-colonic disease location and biological therapy use are significant factors in surgical decision-making.

Over half of CD patients in the study required surgical treatment during long-term follow-up.

Abstract

To evaluate patient characteristics and factors associated with surgical resection in patients with Crohn’s disease (CD).

An analysis was performed on data from 295 patients with CD in follow-up from 2001 to 2018. Medical record data comprised age, gender, location, behavior and duration of the CD, smoking, and extraintestinal manifestation. Patients were divided into two groups according to the presence or absence of surgical resection.

Out of the 295 patients with CD, 155 underwent surgical resection (53.2% male, mean age: 43.88 ± 14.35 years). The main indications for surgery were stenosis (44.5%), clinical intractability (15.5%), and intra-abdominal fistulas (15.5%). Smoking (
p
< 0.001), longer CD duration (
p
< 0.0001), ileo-colonic location (
p
= 0.003), stenosing behavior (
p
< 0.0001), and fistulizing behavior (p < 0.0001) were significantly associated with surgical resection. Initial use of biological was significantly more frequent in the group of patients without surgical resection (
p
< 0.001).

Patients with CD still frequently need surgical treatment. Smoking (current or past), longer disease time, stenosing and fistulizing behavior, and ileo-colonic localization in CD patients were associated with a higher risk of surgery. Awareness about factors associated with unfavorable outcome allows such patients to be treated more appropriately.

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