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Decreasing Trends in Intestinal Resection and Re-Resection in Crohn's Disease

A Nationwide Cohort Study

Beelen, Evelien M. J. MD*; van der Woude, C. Janneke MD, PhD*; Pierik, Marie J. MD, PhD; Hoentjen, Frank MD, PhD; de Boer, Nanne K. MD, PhD§; Oldenburg, Bas MD, PhD||; van der Meulen, Andrea E. MD,, PhD; Ponsioen, Cyriel I. J. MD, PhD#; Dijkstra, Gerard MD, PhD**; Bruggink, Annette H. PhD††; Erler, Nicole S. Dipl.-Stat.‡‡; Schouten, W. Rudolph MD, PhD§§; de Vries, Annemarie C. MD, PhD* On behalf of the Dutch Initiative on Crohn's and Colitis (ICC)

doi: 10.1097/SLA.0000000000003395
Original Article: PDF Only
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Objective: To assess time trends in intestinal resection and re-resection in Crohn's disease (CD) patients.

Summary of Background Data: CD treatment has changed considerably over the past decades. The effect of these advances on the necessity of intestinal resections and the risk of re-resection is unclear.

Methods: In this nationwide cohort study, adult CD patients with ileocolonic, small bowel, colon, or rectum resections between 1991 and 2015 were included. Data were retrieved from the Dutch nationwide network and registry of histopathology and cytopathology (PALGA). Time trends were analyzed with a broken stick model and Cox proportional hazard model with smoothing splines.

Results: The identified cohort comprised 8172 CD patients (3293/4879 male/female) in whom 10,315 intestinal resections were performed. The annual intestinal resection rate decreased nonlinearly from 22.7/100,000 CD patients (1991) to 2.5/100,000 (2015). A significantly steeper decrease was observed before 1999 (slope −1.56) as compared to subsequent years (slope −0.41) (P < 0.001). Analogous trends were observed for ileocolonic, small bowel, and colon resections. Overall cumulative risk of re-resection was 10.9% at 5 years, 18.6% at 10 years, and 28.3% at 20 years after intestinal resection. The hazard for intestinal re-resection showed a nonlinear decreasing trend, with hazard ratio 0.39 (95% confidence interval 0.36–0.44) in 2000 and hazard ratio 0.25 (95% confidence interval 0.18–0.34) in 2015 as compared to 1991.

Conclusion: Over the past 25 years, intestinal resection rate has decreased significantly for ileocolonic, small bowel, and colonic CD. In addition, current postoperative CD patients are at 75% lower risk of intestinal re-resection.

This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0

*Erasmus University Medical Center, Department of Gastroenterology and Hepatology, Rotterdam, the Netherlands

Maastricht University Medical Center, Department of Gastroenterology and Hepatology, Maastricht, the Netherlands

Radboud University Medical Center, Department of Gastroenterology and Hepatology, Nijmegen, the Netherlands

§Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism Research Institute, Amsterdam, The Netherlands

||University Medical Center Utrecht, Department of Gastroenterology and Hepatology, Utrecht, the Netherlands

Leiden University Medical Center, Department of Gastroenterology and Hepatology, Leiden, the Netherlands

#Amsterdam UMC, Academic Medical Center, Department of Gastroenterology and Hepatology, Amsterdam, the Netherlands

**University of Groningen, Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, the Netherlands

††PALGA, Nationwide Network and Registry of Histopathology and Cytopathology in the Netherlands, Houten, the Netherlands

‡‡Erasmus University Medical Center, Department of Biostatistics, Rotterdam, the Netherlands

§§Erasmus University Medical Center, Department of Surgery, Rotterdam, the Netherlands.

a.c.devries@erasmusmc.nl.

Study concept and design: CJW, AV. Acquisition of data: EB, MP, AB, AV. Statistical analysis: EB, NE. Drafting the manuscript: EB, AV. All authors contributed in analysis and interpretation of the data and have critically revised and accepted the manuscript in its current form.

The authors have no financial relationships relevant to this article to disclose.

The authors have no conflicts of interest to disclose.

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