P2686 - Timing of Index Ileocolic Resection is Associated With Radiographic Recurrence in Patients With Crohn’s Disease

Award: Presidential Poster Award

Elizabeth S. Li, BSc¹, Terry Li, MD², Ravi Shah, MD³, Benjamin Click, MD⁴, Delaney R. Ryan, MPH⁵, Benjamin L. Cohen, MD⁶, Edward Barnes, MD, MPH, FACG⁷, Abel Joseph, MD⁸, Salam Bachour, MD⁹, Jessica Hu, BS⁷, Susell Contreras, BA², Jordan Axelrad, MD, MPH^1
1NYU Grossman School of Medicine, New York, NY; ²NYU Langone Health, New York, NY; ³Cleveland Clinic, Cleveland, OH; ⁴University of Colorado, Aurora, CO; ⁵Cleveland Clinic Lerner Research Institute, Cleveland, OH; ⁶Cleveland Clinic Foundation, Cleveland, OH; ⁷University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC; ⁸Stanford University School of Medicine, Palo Alto, CA; ⁹Brigham and Women's Hospital, Boston, MA

Introduction: Surgical resection in Crohn’s disease (CD) is often reserved for complicated or refractory disease, though studies have suggested a role for early primary ileocolic resection (ICR). We aimed to compare the risk of CD recurrence in patients undergoing early versus late ileocolic resection.

Methods: In a multicenter, retrospective cohort study, patients > 18 years old with CD and an index ICR with available postoperative endoscopy were included. Those with prior ICR or permanent ileostomy were excluded. Baseline and demographic variables were compared using Chi square and Kruskal Wallis. Univariable Cox analysis of endoscopic (Rutgeerts ≥ i2b), radiographic (active inflammation), surgical (repeat ICR), and composite CD recurrence were performed and stratified by timing of ICR from CD diagnosis (≤ 1, 2-5, or ≥ 6 years). Multivariate Cox analysis of CD recurrence by timing of < 1 vs ≥ 1 year was done using established risk factors for recurrence.

Results: A total of 412 patients were included. Median follow up time overall was 3.4 years (IQR 1.9-6.4) and was similar among ICR timing groups, with 109 (26%), 122 (30%), and 181 (44%) patients in the ≤ 1, 2-5, or ≥ 6yrs from diagnosis groups, respectively. In the univariate analysis, compared to patients who received ICR ≥ 6yrs from diagnosis group, rates of radiographic CD recurrence were significantly lower (n = 20, 34%, p = 0.018) in the ≤ 1yr group but not in the 2-5yr group (n = 35, 51%, p = 0.70, Table 1). Endoscopic, surgical, and composite CD recurrence rates also trended lower in the ≤ 1yr group. Multivariate analysis between ICR ≤ 1yr versus > 1yr from CD diagnosis consistently showed numerically lower endoscopic (HR 0.80, 95% CI 0.58-1.11, p = 0.18), radiographic (HR 0.73, 95% CI 0.43-1.26, p = 0.26), surgical (HR 0.39, 95% CI 0.13-1.15, p = 0.087), and composite CD recurrence (HR 0.78, 95% CI 0.57-1.06, p = 0.11) but did not reach statistical significance. Tobacco use (HR 1.69, 95% CI 1.17-2.43, p = 0.005) and postoperative biologic prophylaxis (HR 0.49, 95% CI 1.17-2.43, p < 0.001) were significantly associated with composite postoperative recurrence.

Discussion: Early ICR had lower rates of CD recurrence, though the sample was underpowered to reach statistical significance. These findings suggest the importance of a continued discussion of the potential role for early resection in the management of CD. Importantly, the data reconfirmed the protective effects of early postoperative biologic prophylaxis in preventing CD recurrence.


Disclosures:


Elizabeth S. Li, BSc¹, Terry Li, MD², Ravi Shah, MD³, Benjamin Click, MD⁴, Delaney R. Ryan, MPH⁵, Benjamin L. Cohen, MD⁶, Edward Barnes, MD, MPH, FACG⁷, Abel Joseph, MD⁸, Salam Bachour, MD⁹, Jessica Hu, BS⁷, Susell Contreras, BA², Jordan Axelrad, MD, MPH¹. P2686 - Timing of Index Ileocolic Resection is Associated With Radiographic Recurrence in Patients With Crohn’s Disease, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.