Disease reprogression following surgical resection in Crohn disease

Ileocecal resection (ICR) for stricturing (B2) or internal penetrating (B3) phenotypes of Crohn disease (CD) is associated with higher rate of recurrence. Whether patients are at an increased risk of reprogression to complicated behavior (B2/B3) after index surgery remains unknown.

This retrospective study included adult patients with CD who underwent ICR during 1990-2020. We extracted disease characteristics, preoperative and postoperative treatments. The primary outcome was reprogression to B2/B3 disease following ICR. Multivariable logistic regression was used to assess the association between preoperative phenotype and postoperative disease behavior, adjusting for confounders.

Our study included 297 patients with CD who underwent ICR between 1990-2020. Over half (52%) were male, the mean age at surgery was 36 years, and the mean disease duration was 15 years. At resection, disease phenotypes were B1 (nonstricturing, nonpenetrating) in 20%, B2 in 54%, and B3 in 25%. Postoperatively, 56% of patients received advanced therapy. After a median follow-up period of 14 years, 73% of patients had B1, 23% developed B2, and 4% developed B3 disease. Disease reprogression to B2/B3 disease was independent of preoperative disease behavior (P = .90) with 68%, 74%, and 75% of patients whose disease was B1, B2, or B3 at surgery, respectively, having their disease reclassified as B1 at last follow-up. Only 3% of those who underwent surgery for B3 redeveloped B3 disease.

Recurrence of stricturing or penetrating complications following an initial ileocecal resection is independent of preoperative phenotype in CD under contemporary CD management.