Crohn's disease: risk ofrecurrence andreoperation in adefined population

SUMMARYTwohundredandtenpatients withCrohn's disease (CD)wereidentified inan epidemiological survey ofinflammatory boweldisease intheLeiden Health CareRegion ofthe Netherlands. Thesurvey included allpatients withCD seenbetween 1979-1983. Theduration of disease ranged fromless thanoneyearto48years. Ofthe210patients withCD,118(56%) underwent surgical resection. Sixty onehadanileocaecal resection, 14aproctocolectomy, inseven cases asatwostage procedure; 12asegmental colectomy withend-to-end anastomosis andeight a subtotal colectomy withileostomy. Twenty-one ofthese118patients (18%)hadrecurrences requiring reoperation; in11because ofrecurrence attheanastomotic site. Life table analysis showed that after 10years 17%ofpatients required further resection forrecurrence and8%forrelapse. By 20years therate ofrecurrence hadrisen to56%.Patients overtheageof30atfirst resection wereat 1.5fold greater risk ofrequiring further surgery thanyounger patients. Theinitial site ofdisease played norole inrecurrence andthere wasnoevidence thatpreoperative disease duration, delay in diagnosis, orlate surgery hadanyeffect onrecurrence rates. Thisisoneofthefewcommunity based studies tomeasure recurrence andrelapse. Abalanced appraisal isthat surgery isnotpermanently curative, buttheneedforfurther resection maybelower thanpreviously suggested.