Small Bowel Crohn's Disease Recurrence is Common After Total Proctocolectomy for Crohn's Colitis.

BACKGROUND Surgical intervention for Crohn's involving the colon is often a total proctocolectomy with end ileostomy. There is limited data regarding postoperative small bowel recurrence rates in the recent era. OBJECTIVE We sought to determine the rate of small bowel Crohn's disease recurrence following total proctocolectomy and secondarily define risk factors for disease recurrence. DESIGN Retrospective cohort study. SETTINGS Four hospitals within a single healthcare system. PATIENTS Patients with Crohn's disease undergoing total proctocolectomy with end ileostomy between 2009-2019. MAIN OUTCOMES MEASURES Clinical, endoscopic, radiographic, and/or surgical Crohn's disease recurrence. RESULTS 193 patients were included with a median follow up of 1.8 years (IQR 0.4-4.6). 74.6% (n=144) of patients had been previously exposed to biologic therapy, and 51.3% (n=99) had a history of small bowel Crohn's disease. Postoperatively, 14.5% (n=28) of patients received biologic therapy. Crohn's disease recurrence occurred in 23.3% (n=45) patients with an estimated median 5-year recurrence rate of 40.8% (95%CI 30.2-51.4). Surgical recurrence occurred in 8.8% (n=17) patients with an estimated median 5-year recurrence rate of 16.9% (95%CI 8.5-25.3). On multivariable analysis, prior small bowel surgery for Crohn's disease (HR 2.61, 95%CI 1.42-4.81) and Crohn's diagnosis at age <18 (HR 2.56, 95%CI 1.40-4.71) were associated with Crohn's recurrence. In patients without prior small bowel Crohn's disease, 14.9% (n=14) had Crohn's recurrence with an estimated 5-year overall recurrence rate of 31.1% (95%CI 13.3-45.3) and 5-year surgical recurrence rate of 5.7% (95%CI 0.0-12.0). LIMITATIONS Retrospective design, lack of consistent follow up on all patients. CONCLUSIONS Greater than one-third of patients who underwent total proctocolectomy for Crohn's disease were estimated to have small bowel Crohn's recurrence at 5 years after surgery. Patients with history of small bowel surgery for Crohn's and diagnosis at any early age may benefit from more intensive postoperative surveillance and consideration for early medical prophylaxis. See Video Abstract at http://links.lww.com/DCR/B762.