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The Clinical Features and Predictive Risk Factors for Reoperation in Patients With Perianal Crohn Diseases; A Multi-Center Study of a Korean Inflammatory Bowel Disease Study Group.

Lee JB, Yoon SG, Park KJ, Lee KY, Kim DD, Yoon SN, Yu CS, Korean IBD Study Gro - Ann Coloproctol (2015)

Bottom Line: Data on the patient's demographics, clinical features, and surgical outcomes were analyzed.Among 377 patients, 227 patients were ultimately included in the study.Overall 3-year, 5-year, and 10-year cumulative rates of reoperation-free individuals were 68.8%, 61.2%, and 50.5%, respectively.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Daehang Hospital, Seoul, Korea.

ABSTRACT

Purpose: Perianal lesions are common in Crohn disease, but their clinical course is unpredictable. Nevertheless, predicting the clinical course after surgery for perianal Crohn disease (PCD) is important because repeated operations may decrease patient's quality of life. The aim of this study was to predict the risk of reoperation in patients with PCD.

Methods: From September 1994 to February 2010, 377 patients with PCD were recruited in twelve major tertiary university-affiliated hospitals and two specialized colorectal hospitals in Korea. Data on the patient's demographics, clinical features, and surgical outcomes were analyzed.

Results: Among 377 patients, 227 patients were ultimately included in the study. Among the 227 patients, 64 patients underwent at least one reoperation. The median period of reoperation following the first perianal surgery was 94 months. Overall 3-year, 5-year, and 10-year cumulative rates of reoperation-free individuals were 68.8%, 61.2%, and 50.5%, respectively. In multivariate analysis (Cox-regression hazard model), reoperation was significantly correlated with an age of onset less than 20 years (hazard ratio [HR], 1.93; 95% confidence interval [CI], 1.07-3.48; P = 0.03), history of abdominal surgery (HR, 1.99; 95% CI, 1.08-3.64; P = 0.03), and the type of surgery. Among types of surgery, fistulotomy or fistulectomy was associated with a decreased incidence of reoperation in comparison with incision and drainage (HR, 0.19; 95% CI, 0.09-0.42; P < 0.001).

Conclusion: Young age of onset and a history of abdominal surgery were associated with a high risk of reoperation for PCD, and the risk of reoperation were relatively low in fistulotomy or fistulectomy procedures.

No MeSH data available.


Related in: MedlinePlus

Flow chart for patient inclusion.
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Figure 1: Flow chart for patient inclusion.

Mentions: From September 1994 to February 2010, 377 patients with perianal CD were recruited at 12 major tertiary university-affiliated hospitals and 2 colorectal-specializing hospitals in Korea and were considered for inclusion in this study. Age at diagnosis, disease behavior, and location were categorized according to the Montreal classification. Data on the patients' demographics, clinical features, and surgical outcomes were analyzed to evaluate the risk factors for reoperation for PCD. The factors included in this study protocol were decided at a meeting of the 'inflammatory bowel disease (IBD) Study Group of The Korean Society of Coloproctology, which was held before data collection started. The data were initially collected for the 377 patients, 32 cases were excluded because of incomplete demographic data, and then among the remaining 345 patients, 118 patients with a history of anal surgery for perianal disease were excluded (Fig. 1). Therefore, 227 patients who underwent perianal surgery for PCD for the first time were included in this study. During the follow-up period after the first operation, the rate of reoperation was investigated, and the data were analyzed to determine the risk factors for reoperation.


The Clinical Features and Predictive Risk Factors for Reoperation in Patients With Perianal Crohn Diseases; A Multi-Center Study of a Korean Inflammatory Bowel Disease Study Group.

Lee JB, Yoon SG, Park KJ, Lee KY, Kim DD, Yoon SN, Yu CS, Korean IBD Study Gro - Ann Coloproctol (2015)

Flow chart for patient inclusion.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4644704&req=5

Figure 1: Flow chart for patient inclusion.
Mentions: From September 1994 to February 2010, 377 patients with perianal CD were recruited at 12 major tertiary university-affiliated hospitals and 2 colorectal-specializing hospitals in Korea and were considered for inclusion in this study. Age at diagnosis, disease behavior, and location were categorized according to the Montreal classification. Data on the patients' demographics, clinical features, and surgical outcomes were analyzed to evaluate the risk factors for reoperation for PCD. The factors included in this study protocol were decided at a meeting of the 'inflammatory bowel disease (IBD) Study Group of The Korean Society of Coloproctology, which was held before data collection started. The data were initially collected for the 377 patients, 32 cases were excluded because of incomplete demographic data, and then among the remaining 345 patients, 118 patients with a history of anal surgery for perianal disease were excluded (Fig. 1). Therefore, 227 patients who underwent perianal surgery for PCD for the first time were included in this study. During the follow-up period after the first operation, the rate of reoperation was investigated, and the data were analyzed to determine the risk factors for reoperation.

Bottom Line: Data on the patient's demographics, clinical features, and surgical outcomes were analyzed.Among 377 patients, 227 patients were ultimately included in the study.Overall 3-year, 5-year, and 10-year cumulative rates of reoperation-free individuals were 68.8%, 61.2%, and 50.5%, respectively.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Daehang Hospital, Seoul, Korea.

ABSTRACT

Purpose: Perianal lesions are common in Crohn disease, but their clinical course is unpredictable. Nevertheless, predicting the clinical course after surgery for perianal Crohn disease (PCD) is important because repeated operations may decrease patient's quality of life. The aim of this study was to predict the risk of reoperation in patients with PCD.

Methods: From September 1994 to February 2010, 377 patients with PCD were recruited in twelve major tertiary university-affiliated hospitals and two specialized colorectal hospitals in Korea. Data on the patient's demographics, clinical features, and surgical outcomes were analyzed.

Results: Among 377 patients, 227 patients were ultimately included in the study. Among the 227 patients, 64 patients underwent at least one reoperation. The median period of reoperation following the first perianal surgery was 94 months. Overall 3-year, 5-year, and 10-year cumulative rates of reoperation-free individuals were 68.8%, 61.2%, and 50.5%, respectively. In multivariate analysis (Cox-regression hazard model), reoperation was significantly correlated with an age of onset less than 20 years (hazard ratio [HR], 1.93; 95% confidence interval [CI], 1.07-3.48; P = 0.03), history of abdominal surgery (HR, 1.99; 95% CI, 1.08-3.64; P = 0.03), and the type of surgery. Among types of surgery, fistulotomy or fistulectomy was associated with a decreased incidence of reoperation in comparison with incision and drainage (HR, 0.19; 95% CI, 0.09-0.42; P < 0.001).

Conclusion: Young age of onset and a history of abdominal surgery were associated with a high risk of reoperation for PCD, and the risk of reoperation were relatively low in fistulotomy or fistulectomy procedures.

No MeSH data available.


Related in: MedlinePlus