Recurrence After Ileocolic Resection for Crohn’s Disease: Further Unraveling the Search for Risk Factors
Bibliographic record
Abstract
BACKGROUND: Crohn's disease causes chronic intestinal inflammation, often requiring surgery. Postoperative recurrence is common, especially at the anastomosis, with varying recurrence rates. OBJECTIVE: Identifying risk factors for recurrence is crucial for optimizing treatment. This study aims to assess traditional and novel risk factors, including histological factors, for recurrence in patients undergoing ileocolic resection in a deeply phenotyped regional cohort. DESIGN: A retrospective, multicenter cohort study. SETTINGS: Two large referral medical centers in South Limburg, The Netherlands, with access to integrated electronic health records and scanned historical records. Data on demographics, Crohn's disease characteristics, and perioperative findings were collected, and factors influencing recurrence were analyzed. PATIENTS: A total of 289 consecutive patients aged 16 years or older undergoing ileocolic resection between January 2003 and December 2017 with a confirmed diagnosis of Crohn's disease according to European Crohn's and Colitis Organisation criteria. Patients were followed for a mean of 7.02 years. INTERVENTION: No experimental interventions were administered. Surgical treatment consisted of standard ileocolic resection performed either open or laparoscopically. MAIN OUTCOME MEASURES: The primary outcome was postoperative recurrence, defined as clinical, biochemical, endoscopic, or surgical recurrence. Cox proportional hazards models were used to identify independent predictors. RESULTS: Over a mean follow-up of 7.02 years, 189 (65.4%) developed recurrence. Multivariable analysis identified smoking and pathologic margin involvement as significant risk factors for clinical recurrence. Montreal or B3 classification and open surgery were protective. Surgical recurrence was lower in patients undergoing open surgery. LIMITATIONS: The retrospective design may introduce selection and information bias. Surveillance and prophylactic therapy were not standardized. CONCLUSIONS: This study reinforces the role of smoking, disease behavior, resection margin involvement, and perianal disease as key risk factors for recurrence after ileocolic resection. Harmonizing definitions, data collection, and treatment protocols through international collaboration is essential for advancing clinical management and facilitating large-scale prospective studies. See Video Abstract . RECURRENCIA TRAS RESECCIN ILEOCLICA POR ENFERMEDAD DE CROHN NUEVOS AVANCES EN LA BSQUEDA DE FACTORES DE RIESGO: ANTECEDENTES:La enfermedad de Crohn causa inflamación intestinal crónica, que a menudo requiere cirugía. La recurrencia posoperatoria es frecuente, especialmente en la anastomosis, con tasas de recurrencia variables.OBJETIVO:Identificar los factores de riesgo de recurrencia es fundamental para optimizar el tratamiento. El objetivo de este estudio es evaluar los factores de riesgo tradicionales y novedosos, incluidos los factores histológicos, de recurrencia en pacientes sometidos a resección ileocólica en una cohorte regional con fenotipado profundo.DISEÑO:Estudio de cohorte retrospectivo y multicéntrico.ENTORNO:Dos grandes centros médicos de referencia en el sur de Limburgo, Países Bajos, con acceso a historias clínicas electrónicas integradas y registros históricos escaneados. Se recopilaron datos demográficos, características de la enfermedad de Crohn y hallazgos perioperatorios, y se analizaron los factores que influyen en la recurrencia.PACIENTES:Un total de 289 pacientes consecutivos ≥16 años sometidos a resección ileocólica entre enero de 2003 y diciembre de 2017 con un diagnóstico confirmado de enfermedad de Crohn según los criterios de la Organización Europea de Crohn y Colitis. Se realizó un seguimiento de los pacientes durante una media de 7,02 años.INTERVENCIÓN:No se administraron intervenciones experimentales. El tratamiento quirúrgico consistió en una resección ileocólica estándar realizada de forma abierta o laparoscópica.PRINCIPALES MEDIDAS DE RESULTADO:El resultado principal fue la recurrencia posoperatoria, definida como recurrencia clínica, bioquímica, endoscópica o quirúrgica. Se utilizaron modelos de riesgos proporcionales de Cox para identificar predictores independientes.RESULTADOS:Durante un seguimiento medio de 7,02 años, 189 (65,4 %) desarrollaron recidiva. El análisis multivariable identificó el tabaquismo y la afectación del margen patológico como factores de riesgo significativos para la recidiva clínica. La clasificación de Montreal o B3 y la cirugía abierta fueron protectores. La recidiva quirúrgica fue menor en los pacientes sometidos a cirugía abierta.LIMITACIONES:El diseño retrospectivo puede introducir sesgos de selección e información. La vigilancia y la terapia profiláctica no se estandarizaron.CONCLUSIONES:Este estudio refuerza el papel del tabaquismo, el comportamiento de la enfermedad, la afectación del margen de resección y la enfermedad perianal como factores de riesgo clave para la recurrencia tras la resección ileocólica. La armonización de las definiciones, la recopilación de datos y los protocolos de tratamiento mediante la colaboración internacional es esencial para avanzar en el manejo clínico y facilitar los estudios prospectivos a gran escala. ( AI-generated translation ).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".