Complications and Disease Recurrence after Primary Ileocecal Resection in Pediatric Crohn's Disease: A Multicenter Cohort Analysis

Kay Diederen, Lissy De Ridder, Patrick Van Rheenen, Victorien M. Wolters, Maria L. Mearin, Gerard M. Damen, Tim G. De Meij, Herbert Van Wering, Laura A. Tseng, Matthijs W. Oomen, Justin R. De Jong, Cornelius E. Sloots, Marc A. Benninga, Angelika Kindermann*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: Studies on the outcome of ileocecal resection in pediatric Crohn's disease (CD) have a limited follow-up and fail to assign predictors of adverse outcomes. Therefore, we aimed to investigate (I) the complication and disease recurrence rates and (II) identify risk factors for these adverse outcomes after ileocecal resection for pediatric CD. Methods: This is a retrospective cohort analysis of all children (<18 years) that underwent ileocecal resection as first intestinal resection for CD derived from 7 tertiary hospitals in the Netherlands (1990-2015). Risk factors were identified using multivariable analysis. Results: In total, 122 children were included (52% male; median age 15.5 years [interquartile range 14.0-16.0]). Severe postoperative complications rate was 10%. Colonic disease (odds ratio: 5.6 [95% confidence interval {CI}: 1.3-26.3], P = 0.024), microscopically positive resection margins (odds ratio: 10.4 [95% CI: 1.1-100.8] P = 0.043), and emergency surgery (odds ratio: 6.8 [95% CI: 1.1-42.2], P = 0.038) were risk factors for severe complications. Clinical and surgical recurrence rates after 1, 5 and 10 years were 19%, 49%, 71% and 2%, 12%, 22%, respectively. Female sex (hazard ratio [HR]: 2.1 [95% CI: 1.1-3.8], P = 0.023) was a risk factor for clinical recurrence, whereas ileocecal disease (HR: 3.9 [95% CI: 1.2-12.5], P = 0.024) and microscopically positive resection margins (HR: 9.6 [95% CI: 1.2-74.5], P = 0.031) were risk factors for surgical recurrence. Immediate postoperative therapy reduced the risk of both clinical (HR: 0.3 [95% CI: 0.1-0.6], P = 0.001) and surgical (HR: 0.5 [95% CI: 0.1-0.9], P = 0.035) recurrence. Conclusions: Ileocecal resection is an effective and durable treatment of pediatric CD, although postoperative complications occur frequently. Postoperative therapy may be started immediately to prevent disease recurrence.

Original languageEnglish
Pages (from-to)272-282
Number of pages11
JournalInflammatory Bowel Diseases
Volume23
Issue number2
DOIs
Publication statusPublished - 1 Feb 2017

Cite this

Diederen, K., De Ridder, L., Van Rheenen, P., Wolters, V. M., Mearin, M. L., Damen, G. M., ... Kindermann, A. (2017). Complications and Disease Recurrence after Primary Ileocecal Resection in Pediatric Crohn's Disease: A Multicenter Cohort Analysis. Inflammatory Bowel Diseases, 23(2), 272-282. https://doi.org/10.1097/MIB.0000000000000999