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Post-operative recurrence of Crohn’s disease after definitive stoma: an underestimated risk

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Introduction

Crohn’s disease (CD) is a progressive inflammatory disease affecting the entire gastrointestinal tract. The need for a definitive stoma (DS) is considered as the ultimate phase of damage. It is often believed that the risk of further disease progression is small when a DS has been performed.

Aims

The goals of the study were to establish the rate of CD recurrence above the DS and to identify predictive factors of CD recurrence at the time of DS.

Methods

We retrospectively reviewed all medical records of consecutive CD patients having undergone DS between 1973 and 2010. We collected clinical data at diagnosis, CD phenotype, treatment, and surgery after DS and mortality. Stoma was considered as definitive when restoration of continuity was not possible due to proctectomy, rectitis, anoperineal lesions (APL), or fecal incontinence. Clinical recurrence (CR) was defined as the need for re-introduction or intensification of medical therapy, and surgical recurrence (SR) was defined as a need for a new intestinal resection.

Results

Eighty-three patients (20 males, 63 females) with a median age of 34 years at CD diagnosis were included. The median time between diagnosis and DS was 9 years. The median follow-up after DS was 10 years. Thirty-five patients (42%) presented a CR after a median time of 28 months (2–211) and 32 patients (38%) presented a SR after a median time of 29 months (4–212). In a multivariate analysis, APL (HR = 5.1 (1.2–21.1), p = 0.03) and colostomy at time of DS (HR = 3.8 (1.9–7.3), p = 0.0001) were associated factors with the CR.

Conclusion

After DS for CD, the risk of clinical recurrence was high and synonymous with surgical recurrence, especially for patients with APL and colostomy.

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Authors and Affiliations

  1. Digestive Surgery and Transplantation Unit, Hôpital Huriez, Lille Nord de France University, Lille University Medical Center, F-59000, Lille, France

    Dine Koriche, Charbel Chater & Philippe Zerbib

  2. Lille Inflammation Research International Center LIRIC-UMR 995 Inserm, Université Lille 2/CHRU de Lille; Equipe « IBD and environmental factors: Epidemiology and functional analyses, Lille University, Lille, France

    Dine Koriche, Corinne Gower-Rousseau, Charbel Chater, Benjamin Pariente & Philippe Zerbib

  3. Public Health, Epidemiology and Economic Health Unit, Registre Epimad, Maison Régionale de la Recherche Clinique, Centre Hospitalier Universitaire Régional, CS 70001, 59037, Lille Cedex, France

    Corinne Gower-Rousseau

  4. Biostatistics Unit, EA2694, Lille Nord de France University and Hospital, CHRU, Lille, France

    Alain Duhamel

  5. Unité de Biostatistique, Institut de Cancérologie de Lorraine, Vandoeuvre lès Nancy, France

    Julia Salleron

  6. Hepatogastroenterology Unit, Lille Nord de France University, Lille University Medical Center, F-59000, Lille, France

    Noémie Tavernier, Jean-Frédéric Colombel, Benjamin Pariente & Antoine Cortot

  7. Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA

    Jean-Frédéric Colombel

Authors
  1. Dine Koriche
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  2. Corinne Gower-Rousseau
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  10. Philippe Zerbib
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Correspondence to Charbel Chater.

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Koriche, D., Gower-Rousseau, C., Chater, C. et al. Post-operative recurrence of Crohn’s disease after definitive stoma: an underestimated risk. Int J Colorectal Dis 32, 453–458 (2017). https://doi.org/10.1007/s00384-016-2707-2

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  • DOI: https://doi.org/10.1007/s00384-016-2707-2

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