دورية أكاديمية
Penetrating Crohn Disease Is Not Associated With a Higher Risk of Recurrence After Surgery
| العنوان: | Penetrating Crohn Disease Is Not Associated With a Higher Risk of Recurrence After Surgery |
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| المؤلفون: | Maggiori, Léon, Brouquet, Antoine, Zerbib, Philippe, Lefêvre, Jérémie, Denost, Quentin, Germain, Adeline, Cotte, Eddy, Beyer-Berjot, Laura, Munoz-Bongrand, Nicolas, Desfourneaux, Véronique, Rahili, Amine, Duffas, Jean-Pierre, Pautrat, Karine, Denet, Christine, Bridoux, Valérie, Meurette, Guillaume, Faucheron, Jean-Luc, Loriau, Jérôme, Souche, Regis, Vicaut, Eric, Panis, Yves, Benoist, Stéphane |
| المساهمون: | Hôpital Beaujon, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Bicêtre, Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Bicêtre AP-HP, Le Kremlin-Bicêtre, Centre Hospitalier Régional Universitaire CHU Lille (CHRU Lille), Institut Charles Gerhardt Montpellier - Institut de Chimie Moléculaire et des Matériaux de Montpellier (ICGM), Ecole Nationale Supérieure de Chimie de Montpellier (ENSCM)-Institut de Chimie - CNRS Chimie (INC-CNRS)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), CEREST-TC CHU Saint-Antoine, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Saint-Antoine AP-HP, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Bioingénierie tissulaire (BIOTIS), Université de Bordeaux (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Bordeaux, Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Centre Hospitalier Lyon Sud CHU - HCL (CHLS), Hospices Civils de Lyon (HCL), CHU Marseille, Hopital Saint-Louis AP-HP (AP-HP), Centre Hospitalier Universitaire de Rennes CHU Rennes = Rennes University Hospital Ponchaillou, Centre Hospitalier Universitaire de Nice (CHU Nice), Chirurgie Générale et Digestive Rangueil, Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Hôpital Lariboisière-Fernand-Widal APHP, Hôpital Lariboisière, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal APHP, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Institut Mutualiste de Montsouris (IMM), Service de Chirurgie Digestive CHU Rouen, CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Centre Hospitalier Universitaire de Nantes = Nantes University Hospital (CHU Nantes), Centre Hospitalier Universitaire CHU Grenoble (CHUGA), Centre hospitalier Saint-Joseph Paris, Centre Hospitalier Régional Universitaire Montpellier (CHRU Montpellier), Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal Paris, Hôpital Bicêtre AP-HP, Le Kremlin-Bicêtre |
| المصدر: | ISSN: 0003-4932. |
| بيانات النشر: | HAL CCSD Lippincott, Williams & Wilkins |
| سنة النشر: | 2019 |
| مصطلحات موضوعية: | MESH: Colon/surgery, Crohn Disease/surgery, Crohn Disease/diagnosis, Digestive System Surgical Procedures/methods, Ileum/surgery, Intestinal Perforation/surgery, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology |
| الوصف: | International audience ; OBJECTIVE:The aim of this study was to assess recurrence risk factors following ileocolonic resection (ICR) for Crohn disease (CD) in a nationwide cohort study SUMMARY BACKGROUND DATA:: Recurrence rate after ICR for CD can be up to 60%, but its predictive factors have never been evaluated in large prospective cohort studies.METHODS:From 2013 to 2015, 346 consecutive patients undergoing ICR for CD and a postoperative ileocoloscopy within 6 to 12 months after surgery at 19 academic French centers were included prospectively.RESULTS:Twelve-month postoperative endoscopic (Rutgeerts score ≥i2) and clinical recurrence rates were 57.6% [95% confidence interval (CI), 54.2-61.0] and 11.3% (95% CI, 9-13.6), respectively. A total of 185 patients (54%) had a postoperative CD prophylaxis, comprising thiopurine in 69 (20%), or anti-tumor necrosis factor (TNF) therapy in 93 (27%). In multivariate Cox regression analysis, absence of postoperative smoking {odds ratio [OR] = 0.60 (95% CI, 0.40-0.91); P = 0.016}, postoperative prophylaxis [OR = 0.60 (95% CI, 0.41-0.88); P = 0.009], and penetrating disease behavior [OR = 0.58 (95% CI, 0.39-0.86); P = 0.007] were the only independent predictors of reduced endoscopic recurrence risk. Postoperative prophylaxis [OR 0.31 (95% CI, 0.15-0.66); P = 0.002), and penetrating behavior [OR = 00.36 (95% CI, 0.16-0.81); P = 0.013), were the only independent predictors of reduced clinical recurrence risk. Postoperative anti-TNF therapy was associated with a significant reduction of both 12-month risks of endoscopic (P < 0.001) and clinical (P = 0.019) recurrences.CONCLUSION:Absence of postoperative smoking, CD prophylaxis, and penetrating disease behavior could be independent predictors of reduced postoperative recurrence after ICR for CD. Prophylactic anti-TNF therapy reduces both endoscopic and clinical recurrence rates. It suggests that upfront surgery followed by postoperative anti-TNF therapy is probably the best therapeutic approach for complex CD (penetrating ... |
| نوع الوثيقة: | article in journal/newspaper |
| اللغة: | English |
| العلاقة: | hal-02558225; https://hal.umontpellier.fr/hal-02558225Test |
| DOI: | 10.1097/SLA.0000000000003531 |
| الإتاحة: | https://doi.org/10.1097/SLA.0000000000003531Test https://hal.umontpellier.fr/hal-02558225Test |
| رقم الانضمام: | edsbas.8B8AC867 |
| قاعدة البيانات: | BASE |
| DOI: | 10.1097/SLA.0000000000003531 |
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