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Background <p>Crohn’s disease (CD) negatively impacts quality of life, and a high percentage of patients will need surgery. Ileocecal resection (ICR) is the most common abdominal procedure performed in CD. Postoperative complications are frequent, and recurrence is common. The main objectives of this study were to analyze risk factors (RF) for anastomotic leakage (AL) and recurrence after ICR, as well as quality of life (QoL) in CD in a sample of the Spanish population.</p> Methods <p>A prospective, multicenter, observational study was designed, including all types of hospitals in Spain from 2018 to 2021. Demographic and medical–surgical characteristics, postoperative complications, hospital types by annual ICR volume, and quality of life (IBDQ-9) up to 1&#xa0;year follow-up (OYF) were recorded and analyzed.</p> Results <p>A total of 386 ICRs were recorded. At 60&#xa0;days, there were 134 (36.4%) complications, 46 (11.91%) of which were major. A total of 23 (5.9%) AL were registered, and RF were Montreal A3 [OR 14.2, 95% CI (2.70–126), <i>p</i> = 0.005], Montreal p [OR 7.29, 95% CI (1.14–44.4), <i>p</i> = 0.029], and intensified adalimumab treatment [3.8, 95% CI (1.2–13.1), <i>p</i> = 0.026]. Recurrences at OYF were 67 (19%), and RF were history of neoplasia [OR 7.14, <i>p</i> = 0.01], Montreal B3 [OR 2.12, <i>p</i> = 0.02], and minimally invasive surgery (MIS) [OR 2.63, <i>p</i> = 0.02]. The mean difference in IBDQ-9 from baseline to 60&#xa0;days was +1.72 (<i>n</i> = 177, <i>p</i> &lt; 0.001) and to OYF +2.12 (<i>n</i> = 140, <i>p</i> &lt; 0.001).</p> Conclusions <p>The AL rate was 5.9%. Montreal A3, perianal disease, and intensified adalimumab were associated with a higher rate of AL. The recurrence rate was 17.6% (OYF). Prior neoplasia, Montreal B3, and MIS were associated with higher risk of recurrence. ICR improves quality of life at 60&#xa0;days and is maintained 1&#xa0;year after surgery.</p> Graphical abstract <p></p>

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Patterns and predictors of postoperative complications and recurrence after ileocecal resection for Crohn’s disease: a national multicenter longitudinal study

  • 期刊论文

  • 发表日期：

    2025年2月8日

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  • A. Soler-Silva,
  • L. Sánchez-Guillén,
  • F. Blanco-Antona,
  • X. Barber,
  • M. Millán,
  • J. M. Enriquez-Navascues,
  • G. Elorza-Echaniz,
  • J. Die Trill,
  • J. Ocaña Jimenez,
  • D. Moro-Valdezate,
  • C. Leon-Espinoza,
  • V. Primo-Romaguera,
  • J. Sancho-Muriel,
  • I. Pascual Migueláñez,
  • J. Saavedra,
  • P. Penín de Oliveira,
  • F. Meceira Quintian,
  • M. Carmona Agúndez,
  • I. M. Gallarín Salamanca,
  • R. Lopez de los Reyes,
  • E. Vives Rodriguez,
  • A. Navarro-Sánchez,
  • I. Soto-Darias,
  • I. Monjero Ares,
  • M. I. Torres García,
  • I. Aldrey,
  • E. M. Barreiro Dominguez,
  • S. Diz Jueguen,
  • J. C. Bernal Sprekelsen,
  • P. Ivorra García-Moncó,
  • V. Vigorita,
  • M. Nogueira Sixto,
  • C. Martín Dieguez,
  • M. López Bañeres,
  • T. Pérez Pérez,
  • E. Añón Iranzo,
  • R. Vázquez-Bouzán,
  • E. Sánchez Espinel,
  • I. Alberdi San Roman,
  • A. Trujillo Barbadillo,
  • R. Martínez-García,
  • F. J. Menárguez Pina,
  • R. Anula Fernández,
  • J. A. Mayol Martínez,
  • A. Romero de Diego,
  • B. De Andres-Asenjo,
  • N. Ibáñez Cánovas,
  • J. Abrisqueta Carrión,
  • M. Estaire Gómez,
  • R. H. Lorente Poyatos,
  • D. Julià-Bergkvist,
  • N. Gómez-Romeu,
  • M. Romero-Simó,
  • F. Mauri-Barberá,
  • A. Arroyo,
  • M. J. Alcaide-Quiros,
  • J. V. Hernandis Villalba,
  • J. Espinosa Soria,
  • D. Parés,
  • J. Corral,
  • L. M. Jiménez-Gómez,
  • J. Zorrilla Ortúzar,
  • I. Abellán Morcillo,
  • A. Bernabé Peñalver,
  • P. A. Parra Baños,
  • J. M. Muñoz Camarena,
  • L. Abellán Garay,
  • M. Milagros Carrasco,
  • M. P. Rufas Acín,
  • D. Ambrona Zafra,
  • M. H. Padín Álvarez,
  • P. Lora Cumplido,
  • L. Fernández-Cepedal,
  • J. M. García-González,
  • E. Pérez Viejo,
  • D. Huerga Álvarez,
  • A. Valle Rubio,
  • V. Jiménez Carneros,
  • B. Arencibia-Pérez,
  • C. Roque-Castellano,
  • R. Ríos Blanco,
  • B. Espina Pérez,
  • A. Caro Tarrago,
  • R. Saeta Campo,
  • A. Illan Riquelme,
  • E. Bermejo Marcos,
  • A. Rodríguez Sánchez,
  • C. Cagigas Fernández,
  • L. Cristóbal Poch,
  • M. V. Duque Mallen,
  • M. P. Santero Ramírez,
  • M.d. M. Aguilar Martínez,
  • A. Moreno Navas,
  • J. M. Gallardo Valverde,
  • E. Choolani Bhojwani,
  • S. Veleda Belanche,
  • C. R. Díaz-Maag,
  • R. Rodríguez-García,
  • A. Alberca Páramo,
  • N. Pineda Navarro,
  • E. Ferrer Inaebnit,
  • N. Alonso Hernández,
  • M. Ferrer-Márquez,
  • Z. Gómez-Carmona,
  • M. Ramos Fernandez,
  • E. Sanchiz Cardenas,
  • J. Valdes-Hernandez,
  • A. Pérez Sánchez,
  • M. Labalde Martínez,
  • F. J. García Borda,
  • S. Fernández Arias,
  • M. Fernández Hevia,
  • T. Elosua González,
  • L. Jimenez Alvarez

摘要

Background

Crohn’s disease (CD) negatively impacts quality of life, and a high percentage of patients will need surgery. Ileocecal resection (ICR) is the most common abdominal procedure performed in CD. Postoperative complications are frequent, and recurrence is common. The main objectives of this study were to analyze risk factors (RF) for anastomotic leakage (AL) and recurrence after ICR, as well as quality of life (QoL) in CD in a sample of the Spanish population.

Methods

A prospective, multicenter, observational study was designed, including all types of hospitals in Spain from 2018 to 2021. Demographic and medical–surgical characteristics, postoperative complications, hospital types by annual ICR volume, and quality of life (IBDQ-9) up to 1 year follow-up (OYF) were recorded and analyzed.

Results

A total of 386 ICRs were recorded. At 60 days, there were 134 (36.4%) complications, 46 (11.91%) of which were major. A total of 23 (5.9%) AL were registered, and RF were Montreal A3 [OR 14.2, 95% CI (2.70–126), p = 0.005], Montreal p [OR 7.29, 95% CI (1.14–44.4), p = 0.029], and intensified adalimumab treatment [3.8, 95% CI (1.2–13.1), p = 0.026]. Recurrences at OYF were 67 (19%), and RF were history of neoplasia [OR 7.14, p = 0.01], Montreal B3 [OR 2.12, p = 0.02], and minimally invasive surgery (MIS) [OR 2.63, p = 0.02]. The mean difference in IBDQ-9 from baseline to 60 days was +1.72 (n = 177, p < 0.001) and to OYF +2.12 (n = 140, p < 0.001).

Conclusions

The AL rate was 5.9%. Montreal A3, perianal disease, and intensified adalimumab were associated with a higher rate of AL. The recurrence rate was 17.6% (OYF). Prior neoplasia, Montreal B3, and MIS were associated with higher risk of recurrence. ICR improves quality of life at 60 days and is maintained 1 year after surgery.

Graphical abstract