P738 Surgery for Crohn’s Disease: Results from a Spanish cohort with 15 years of follow-up

Abstract

Background Crohn’s disease (CD) is a lifelong disease. Knowing the natural history is essential to understand the evolution of the illness, assess the impact of different therapeutic strategies, identify poor prognostic factors and provide patients with understandable information who help them in decision-making. One of the most relevant features in natural history of Crohn’s Disease (CD) are surgery requirements. Methods We performed a retrospective study that includes all patients with a definitive diagnosis (DD) of CD in the Navarra Incident Cohort (which includes all patients diagnosed between 2001 and 2003 in Navarra, Spain). Our objectives were to analyze the cumulative incidence of surgical resection and to identify predictive factors for surgery. Results We included 94 patients with DD of CD (L1 46.8% / L2 17% / L3 36.2%) 49 were men, median age at diagnosis of 34 years (7-75) and with a median follow-up of 15.6 years. At the end of the follow-up, 42.5% of the patients had undergone surgery, 33 (35%) intestinal resection, 7 (7.5%) surgery for perianal disease (PAD) and three (3%) for both reasons. In total 59 interventions were performed, 19 of them for PAD. The cumulative incidence of intestinal resection in our series was 5.3% at diagnosis, 8.5% at one year, 22.4% at 5 years, 29.9% at 10 years, 44.6% at 15 years, and 68.3% at the end of the follow-up (fig A). In 82% of cases a single resection was performed and in 6 patients 2 resections were performed. The surgery was elective in 80% of the cases. Before the intervention, all had received corticosteroids or 5-ASA, 25% (8) immunomodulators and 21% (7) biological agents. The most frequent indication was symptomatic stenosis (45%) followed by inflammatory abscess (25%). In the univariate analysis, age at diagnosis, sex, L4 involvement, extraintestinal manifestations, and Harvey-Bradshaw index were not associated to the probability of intestinal resection. Disease location and behaviour were associated with more probability of resection (fig B and C). In the multivariate analysis, penetrating behaviour (B3 vs B1) was an independent risk factor associated with resective surgery (HR 14.48; 95% CI 4.17-50.3; p <0.001) while ileocolonic disease (L3) was a protective factor compared with ileal location (L1) (HR 0.32; 95% CI 0.12-0.84; p = 0.02) Conclusion - In our cohort 5.3% of patients require intestinal resection at diagnosis and the cumulative incidence at 15 years of 45% - Penetrating behavior was an independent risk factor for surgery and ileocolonic location a protective factor