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Updated: Jun 13, 2026
Murine Ileocolic Bowel Resection with Primary Anastomosis
Published on: October 29, 2014
Risk Factors for Small-Bowel Crohn's Disease Recurrence After Total Proctocolectomy
Maxwell D Mirande1, Ana Sofia Ore1, Emily G Flaherty2
1Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota.
Background:
Surgical management of Crohn's disease of the colon and rectum frequently requires total proctocolectomy with end ileostomy. There are limited data on the need for Crohn's disease-directed therapy and the prevalence of recurrence after surgery.
Objective:
To determine the risk of small-bowel Crohn's disease recurrence and evaluate risk factors for postoperative recurrence after total proctocolectomy with end ileostomy.
Design:
Retrospective cohort study.
Settings:
Multistate tertiary health care system.
Patients:
Adult patients with Crohn's disease undergoing total proctocolectomy with end ileostomy between 2014 and 2023.
Main Outcome Measures:
The primary outcome was small-bowel Crohn's disease recurrence.
Results:
A total of 193 patients with a median age of 45 years (interquartile range, 34-61) were included. More than half of the patients (n = 102; 52.9%) had a history of small-bowel Crohn's disease, and the majority (n = 134; 69.4%) received biologic therapy before surgery. The median follow-up time was 4.8 years (interquartile range, 2.0-7.6). Postoperatively, 30.6% of patients (n = 59) received biologic therapy. Thirty-five patients (18.1%) had small-bowel Crohn's disease recurrence for an estimated 5-year recurrence-free rate of 80.2% (95% CI, 73.0-85.7). Seven patients (3.6%) developed small-bowel Crohn's disease recurrence requiring surgery for an estimated 5-year surgical recurrence-free rate of 94.7% (95% CI, 89.0-97.5). On multivariable analysis, history of small-bowel Crohn's disease (HR 2.17; 95% CI' 1.04-4.54) and diagnosis at age younger than 18 years (HR 2.31; 95% CI'1.1-4.86) were associated with small-bowel Crohn's disease recurrence.
Limitations:
Retrospective design and nonstandardized follow-up.
Conclusions:
Patients undergoing total proctocolectomy with end ileostomy for Crohn's disease have approximately a 20% risk of small-bowel recurrence at 5 years but a low risk of requiring surgical intervention. Patients with a history of small-bowel Crohn's disease and younger age at diagnosis have a higher risk of recurrence and may warrant consideration of more frequent surveillance and medical prophylaxis. See Video Abstract .
Factores De Riesgo De Recurrencia De La Enfermedad De Crohn Del Intestino Delgado Despus De Una Proctocolectoma Total:
ANTECEDENTES:El tratamiento quirúrgico de la enfermedad de Crohn del colon y el recto frecuentemente requiere proctocolectomía total con ileostomía terminal. Existe información limitada sobre la necesidad de terapia dirigida a la enfermedad de Crohn y la prevalencia de recurrencia tras la cirugía.OBJETIVO:Determinar el riesgo de recurrencia de la enfermedad de Crohn del intestino delgado y evaluar los factores de riesgo de recurrencia posoperatoria tras proctocolectomía total con ileostomía terminal.DISEÑO:Estudio de cohorte retrospectivo.ÁMBITO:Sistema de atención médica terciaria multiestatal.PACIENTES:Pacientes adultos con enfermedad de Crohn sometidos a proctocolectomía total con ileostomía terminal entre 2014 y 2023.PRINCIPALES MEDIDAS DE RESULTADO:El resultado primario fue la recurrencia de la enfermedad de Crohn del intestino delgado.RESULTADOS:Se incluyeron un total de 193 pacientes con una mediana de edad de 45 años (RIC, 34-61). Más de la mitad de los pacientes (n = 102, 52,9 %) tenían antecedentes de enfermedad de Crohn del intestino delgado y la mayoría (n = 134, 69,4 %) recibieron terapia biológica antes de la cirugía. El tiempo medio de seguimiento fue de 4,8 años (RIC, 2,0-7,6). Después de la cirugía, el 30,6 % de los pacientes (n = 59) recibieron terapia biológica. Treinta y cinco pacientes (18,1 %) tuvieron recurrencia de la enfermedad de Crohn del intestino delgado para una tasa estimada libre de recurrencia a 5 años del 80,2 % (IC del 95 %, 73,0-85,7). Siete pacientes (3,6 %) desarrollaron recurrencia de la enfermedad de Crohn del intestino delgado que requirió cirugía para una tasa estimada libre de recurrencia quirúrgica a 5 años del 94,7 % (IC del 95 %, 89,0-97,5). En el análisis multivariable, los antecedentes de enfermedad de Crohn del intestino delgado (HR 2,17; IC del 95%: 1,04-4,54) y el diagnóstico antes de los 18 años (HR 2,31; IC del 95%: 1,1-4,86) se asociaron con la recurrencia de la enfermedad de Crohn del intestino delgado.LIMITACIONES:Diseño retrospectivo y seguimiento no estandarizado.CONCLUSIONES:Los pacientes sometidos a proctocolectomía total con ileostomía terminal por enfermedad de Crohn tienen aproximadamente un 20% de riesgo de recurrencia en el intestino delgado a los 5 años, pero un bajo riesgo de requerir intervención quirúrgica. Los pacientes con antecedentes de enfermedad de Crohn del intestino delgado y menor edad al diagnóstico tienen un mayor riesgo de recurrencia y podrían requerir una vigilancia más frecuente y profilaxis médica. (AI-generated translation ).
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