Post-Operative Recurrence of Colonic Crohn's Disease After Colectomy: The RESECOL Study by the Young Group of GETECCU

Post-operative recurrence (POR) of colonic Crohn's Disease (CD) after segmental (SC) or subtotal colectomy (STC) is scarcely described. Therefore, we aimed to report the rates and predictors of POR in this setting.

Multicentre, nationwide, retrospective study including colonic CD patients undergoing SC or STC. Clinical, endoscopic, radiologic and surgical POR were assessed and POR-free survival was compared between procedures. Cox regression determined predictors of post-colectomy POR. Inverse probability of treatment weighting (IPTW) was carried out for sensitivity analyses.

A total of 224 patients were included (157 SC, 67 STC). Clinical POR occurred less frequently after SC than after STC (38% vs 63%, p = 0.001), as did endoscopic POR (50% vs 71%, p = 0.012); whereas radiologic and surgical POR rates were similar (p = 0.1 and p = 0.992, respectively). Clinical POR-free survival at 1 and 5 years was higher after SC than after STC (82% and 64.8% vs 67.6% and 39%, log-rank p = 0.001). Endoscopic POR-free survival followed a similar pattern (log-rank p < 0.001). In multivariable Cox regression, SC remained protective against clinical (HR 0.54 [0.36-0.81]) and early endoscopic POR (HR 0.54 [0.35-0.82]). After IPTW, SC was still associated with a significantly lower risk of clinical and endoscopic POR.

Clinical and endoscopic POR rates are significantly lower following SC compared with STC in colonic CD, while radiologic and surgical recurrence rates were similar. SC shows a protective effect regarding clinical and early endoscopic POR. These data support segmental resection of colonic CD when feasible.