TY - JOUR
T1 - Rate of Reoperation Decreased Significantly After Year 2002 in Patients With Crohn's Disease
AU - Shinagawa, Takahide
AU - Hata, Keisuke
AU - Ikeuchi, Hiroki
AU - Fukushima, Kouhei
AU - Futami, Kitaro
AU - Sugita, Akira
AU - Uchino, Motoi
AU - Watanabe, Kazuhiro
AU - Higashi, Daijiro
AU - Kimura, Hideaki
AU - Araki, Toshimitsu
AU - Mizushima, Tsunekazu
AU - Itabashi, Michio
AU - Ueda, Takeshi
AU - Koganei, Kazutaka
AU - Oba, Koji
AU - Ishihara, Soichiro
AU - Suzuki, Yasuo
N1 - Funding Information:
The authors thank Editage (www.editage.jp) for English language editing. The authors express their deep condolences and gratitude to the late professor Toshiaki Watanabe. Conflicts of interest These authors disclose the following: Keisuke Hata has received personal fees from EA Pharma, Nippon Kayaku, Mitsubishi Tanabe Pharma, AbbVie GK, Kyorin Pharmaceuticals, Kissei Pharmaceuticals, Mochida Pharmaceuticals, Zeria Pharmaceuticals, Takeda Pharmaceuticals, AstraZeneca, JIMRO, and Janssen Pharmaceuticals while conducting the study; Hiroki Ikeuchi has received personal fees from EA Pharma, Nippon Kayaku, Mitsubishi Tanabe Pharma, AbbVie GK, Kyorin Pharmaceuticals, Kissei Pharmaceuticals, Mochida Pharmaceuticals, Zeria Pharmaceuticals, Takeda Pharmaceuticals, AstraZeneca, Miyarisan Pharmaceutical, and Janssen Pharmaceuticals while conducting the study; Kitaro Futami has received commercial research grants from Takeda Pharmaceutical, Mitsubishi TanabePharma, AbbVie GK, EA Pharma, and Kyorin Pharmaceuticals while conducting the study; Akira Sugita has received personal fees from EA Pharma, AbbVie GK, Mitsubishi Tanabe Pharma, Kyorin Pharnaceuticals, Mochida Pharmaceticals, and Pfizer while conducting the study; Motoi Uchino has received personal fees from EA Pharma, Mitsubishi Tanabe Pharma, AbbVie GK, Kyorin Pharmaceuticals, and Zeria Pharmaceuticals while conducting the study; Kazuhiro Watanabe has received personal fees from AbbVie GK, Shire Japan, and Takeda Pharmaceuticals while conducting the study; Daijiro Higashi has received personal fees from Mitsubishi Tanabe Pharma, Kyorin Pharmaceuticals, and AstraZeneca while conducting the study; Hideaki Kimura has received personal fees from Mitsubishi Tanabe Pharma, EA Pharma, Zeria Pharmaceuticals, and Janssen Pharmaceuticals while conducting the study; Tsunekazu Mizushima has received research grants or personal fees from AbbVie GK, Asstellas Pharma, EA Pharma, Mitsubishi Tanabe Pharma, Miyarisan Pharmaceutical, Pfizer Japan, and Takeda Pharmaceuticals while conducting the study; Michio Itabashi has received personal fees from Taiho Pharmaceutical Co, Ltd, Pfizer Japan, Astellas Pharma, Inc, Chugai Pharmaceutical Co, Ltd, and Takeda Pharmaceuticals, Co, Ltd while conducting the study; Takeshi Ueda has received personal fees from Mitsubishi Tanabe Pharma, AbbVie GK, Kyorin Pharmaceuticals, Kissei Pharmaceuticals, Takeda Pharmaceuticals, and EA Pharma while conducting the study; Kazutaka Koganei has received personal fees from Kyorin Pharmaceuticals Co, Ltd, AbbVie GK, Mochida Pharmaceutical Co, Ltd, Jansen Pharmaceutical KK, Mitsubishi Tanabe Pharma, EA Pharma, and Zeria Pharmaceutical Co, Ltd while conducting the study; Koji Oba has received honoraria from Eisai Co, Ltd, Chugai Pharmaceutical Co, Ltd, Daiichi-Sankyo Pharmaceutical Co, Ltd, Asahi Kasei Pharma Corp, Takeda Pharmaceuticals, Co, Ltd, and Ono Pharmaceutical Co, Ltd; Soichiro Ishihara has received commercial research grants from Yakult Honsha, Chugai Pharmaceutical, Takeda Pharmaceutical, Merck Biopharma, Mitsubishi Tanabe Pharma, Miyarisan Pharmaceutical, and Eli Lilly; and Yasuo Suzuki has received speaking fees from AbbVie GK, Mitsubishi Tanabe Pharma, Zeria, Mochida Pharmaceutical Co, Ltd, Kyorin Pharmaceutical Co, Ltd, and Janssen, and has received research grants from AbbVie GK, Mitsubishi Tanabe Pharma, EA Pharma Co, Ltd, JIMRO Co, Ltd, Mochida Pharmaceutical Co, Ltd, and Kissei Pharmaceutical Co., Ltd. The remaining authors disclose no conflicts. Funding This work is partially supported by the Research Group for Intractable Inflammatory Bowel Disease of the Ministry of Health, Labour and Welfare of Japan (RGIBD).
Publisher Copyright:
© 2020 AGA Institute
PY - 2020/4
Y1 - 2020/4
N2 - Background & Aims: Patients with Crohn's disease (CD) can require multiple intestinal surgeries. We examined time trends and risk factors for reoperation in patients with CD who underwent intestinal surgery, focusing on the effects of postoperative medical treatments. Methods: We performed a retrospective analysis of 1871 patients with CD who underwent initial intestinal resection at 10 tertiary care institutions in Japan, with an initial surgical date after May 1982. We collected data on the background characteristics of all patients, including Montreal Classification, smoking status, and medical therapy after surgery (tumor necrosis factor antagonists [anti-TNF] agents or immunomodulators). The primary outcome was requirement for first reoperation. Rate of reoperation was estimated using the Kaplan–Meier method, and risk factors for reoperation were identified using the Cox regression model. Results: The overall cumulative 5- and 10-year reoperation rates were 23.4% and 48.0%, respectively. Multivariable analysis showed that patients who underwent the initial surgery after May 2002 had a significantly lower rate of reoperation than patients who underwent surgery before April 2002 (hazard ratio [HR], 0.72; 95% CI, 0.61–0.86). Preoperative smoking (HR, 1.40; 95% CI, 1.18–1.68), perianal disease (HR, 1.50; 95% CI, 1.27–1.77), and ileocolic type of CD (HR, 1.42; 95% CI, 1.20–1.69) were significant risk factors for reoperation. Postoperative use of immunomodulators (HR, 0.60; 95% CI, 0.44–0.81) and anti-TNF therapy (HR, 0.71; 95% CI, 0.57–0.88) significantly reduced the risk. Anti-TNF was effective in the bionaive subgroup. Conclusions: The rate of reoperation in patients with CD significantly decreased after May 2002. Postoperative use of anti-TNF agents might reduce the reoperation rate for bionaive patients with CD.
AB - Background & Aims: Patients with Crohn's disease (CD) can require multiple intestinal surgeries. We examined time trends and risk factors for reoperation in patients with CD who underwent intestinal surgery, focusing on the effects of postoperative medical treatments. Methods: We performed a retrospective analysis of 1871 patients with CD who underwent initial intestinal resection at 10 tertiary care institutions in Japan, with an initial surgical date after May 1982. We collected data on the background characteristics of all patients, including Montreal Classification, smoking status, and medical therapy after surgery (tumor necrosis factor antagonists [anti-TNF] agents or immunomodulators). The primary outcome was requirement for first reoperation. Rate of reoperation was estimated using the Kaplan–Meier method, and risk factors for reoperation were identified using the Cox regression model. Results: The overall cumulative 5- and 10-year reoperation rates were 23.4% and 48.0%, respectively. Multivariable analysis showed that patients who underwent the initial surgery after May 2002 had a significantly lower rate of reoperation than patients who underwent surgery before April 2002 (hazard ratio [HR], 0.72; 95% CI, 0.61–0.86). Preoperative smoking (HR, 1.40; 95% CI, 1.18–1.68), perianal disease (HR, 1.50; 95% CI, 1.27–1.77), and ileocolic type of CD (HR, 1.42; 95% CI, 1.20–1.69) were significant risk factors for reoperation. Postoperative use of immunomodulators (HR, 0.60; 95% CI, 0.44–0.81) and anti-TNF therapy (HR, 0.71; 95% CI, 0.57–0.88) significantly reduced the risk. Anti-TNF was effective in the bionaive subgroup. Conclusions: The rate of reoperation in patients with CD significantly decreased after May 2002. Postoperative use of anti-TNF agents might reduce the reoperation rate for bionaive patients with CD.
KW - Environmental Factor
KW - IBD
KW - Inflammatory Bowel Disease
KW - Outcomes
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U2 - 10.1016/j.cgh.2019.07.025
DO - 10.1016/j.cgh.2019.07.025
M3 - Article
C2 - 31336198
AN - SCOPUS:85076531381
VL - 18
SP - 898-907.e5
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
SN - 1542-3565
IS - 4
ER -