Ann Surg. 2021 Aug 1;274(2):346-351. doi: 10.1097/SLA.0000000000003660.

Bryan P Kline ¹, Taelor Weaver ¹, David L Brinton Jr ¹, Leonard Harris ¹, Gregory S Yochum ^1 2, Arthur S Berg ^1 3, Walter A Koltun ¹

Author information

¹Department of Surgery, Division of Colon and Rectal Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA.

²Department of Biochemistry and Molecular Biology, The Pennsylvania State University, College of Medicine, Hershey, PA.

³Department of Public Health Sciences, Division of Biostatistics and Bioinformatics, The Pennsylvania State University, College of Medicine, Hershey, PA USA.

Abstract

Objective: The aim of this study was to evaluate factors associated with time to surgical recurrence after Crohn's ileocolectomy.

Summary background data: The most common surgery performed for Crohn's disease is ileocolectomy. Identifying patients at high risk for surgical recurrence may assist with medical and surgical decision-making.

Methods: Data were obtained from 409 patients with Crohn's disease (CD) who had undergone ≥1 ileocolectomies at Penn State Hershey Medical Center. Six single-nucleotide polymorphisms (SNPs) associated with CD were evaluated in these patients: rs2076756, rs2066844, and rs2066845 in NOD2, rs4958847 and rs13361189 in IRGM, and rs2241880 in ATG16L1. Genotype and clinical factors were analyzed to determine associations with time to recurrent ileocolectomy. A subgroup analysis was performed on 241 patients naïve to biologics before initial ileocolectomy to assess the effect of biologic therapy on time to recurrent surgery.

Results: There were 286 patients who underwent a single ileocolectomy, whereas 123 required multiple ileocolectomies. Ileocolonic involvement [hazard ratio (HR) 1.90, 95% confidence interval (CI) 1.21-3.00, P = 0.006] and rs2066844 in NOD2 (HR 1.8, 95% CI 1.17-2.77, P = 0.007) were associated with decreased time to surgical recurrence by multivariate analysis. In patients naïve to preoperative biologics, the initiation of postoperative biologics was associated with a 40% decreased incidence of surgical recurrence (HR 0.60, CI 0.39-0.93, P = 0.02) over time.

Conclusions: Ileocolonic distribution of disease and the rs2066844 SNP in NOD2 are associated with shorter time to recurrent ileocolectomy. The initiation of postoperative biologics in naïve patients was associated with a reduced incidence of recurrence over time.