Postoperative Recurrence of Crohn’s Disease in Relation to Radicality of Operation and Sulfasalazine Prophylaxis: A Multicenter Trial

Abstract

Recurrence rate is high after operation for Crohn’s disease. A multicenter trial was performed to study the effect of radical or nonradical operation and of sulfasalazine prophylaxis versus placebo on postoperative recurrence rate in 232 patients with Crohn’s disease. Sixteen medical and surgical centers participated in the study, 7 operating radically and 9 nonradically. The follow-up period lasted 3 years, the allocation to drug treatment was randomized and double blind. Recurrence was significantly less frequent and occurred later in patients who were operated nonradically. Patients on sulfasalazine prophylaxis had a better prognosis than on placebo. This effect was statistically significant in the first 2 years of treatment. Both strategies were additive: nonradical operation and sulfasalazine had the best prognosis, radical operation and placebo was worst. It is concluded that postoperative recurrence is best prevented by resecting nonradically and prescribing 3 g of sulfasalazine daily at least over 2 years.

Management of Crohn's Disease in Adults

“…ere continues to be an expanding body of evidence in favor of postoperative therapy to delay endoscopic and clinical recurrence of CD (77,238) . One trial from the 1980s demonstrated bene ts from sulfasalazine at doses greater than 3 g daily (239) , but most recent studies have focused on attempts at postoperative prophylaxis with mesalamine. Although early trials have demonstrated bene ts for mesalamine, >3 g daily, at reducing the risk of postoperative recurrence for up to 3 years in subgroups of patients (240) , more recent controlled trials have been less supportive (241,242) .…”

Review: Current trends in inflammatory bowel disease: the natural history

“…Extensive or radical surgery with disease free margins is not effective in preventing disease recurrence. On the contrary, nonradical or less extensive surgery seems to cause fewer and later recurrences [Ewe et al 1989]. At present there is no known treatment which is completely effective in preventing disease recurrence.…”

Untitled

“…A highly significant response (62% vs. 7%), however, was found as measured by a biochemical index following 6 g SASP for 26 weeks in patients with active CD in a small placebo-controlled study (126). Other studies report on varying effects of SASP in CD, but the lack of placebocontrol (92, 123) or consistent criteria for inclusion or endpoints weakens their conclusion (37) as to the actual clinical benefit in active and quiescent disease.…”