Prognostic value of the modified Rutgeerts' score for long-term outcomes after primary ileocecal resection in Crohn's disease.

The prognostic value of the modified Rutgeerts score (mRS) in patients with Crohn's disease (CD) needs to be further elucidated. This study assessed the prognostic value of the mRS for long-term outcomes after primary ileocecal resection (ICR) in patients with CD. CD patients after primary ICR with an available mRS at first postoperative ileocolonoscopy (index mRS) were retrospectively included. Primary outcome was surgical recurrence. Secondary outcomes were clinical recurrence and progression to severe endoscopic recurrence (≥i3). Cox proportional hazard models were used to assess the association between index mRS and outcomes. 652 patients were included (mean follow-up: 6.4 years, SD: 4.6). Surgical recurrence rates were 7.7%, 5.3%, 12.9%, 19.1%, 28.8%, 47.8% for index mRS i0, i1, i2a, i2b, i3 and i4. Clinical recurrence occurred in 42.2%(i0), 53.7%(i1), 58.5%(i2a), 80.2%(i2b), 79.4%(i3) and 95.3%(i4). Progression to severe endoscopic recurrence occurred in 21.1%(i0), 33.9%(i1), 26.8% (i2a) and 33.3%(i2b). An index mRS of i2b (adjusted hazard ratio [aHR] 3.0; 1.5-5.6), i3 (aHR 4.0;2.0-7.9) and i4 (aHR 8.0; 4.0-16.0) were associated with surgical recurrence. An index mRS of i1 (aHR 1.7; 1.2-2.4), i2a (aHR 1.7; 1.2-2.4), i2b (aHR 4.4; 3.2-6.0), i3 (aHR 3.6; 2.5-5.2) and i4 (aHR 7.3; 4.8-10.9) were associated with clinical recurrence. An index mRS of i1 (aHR 2.0;1.1-3.7) or i2b (aHR 2.5;1.4-4.6) were associated with progression to severe endoscopic recurrence. The increasing mRS corresponds closely with the risk for surgical and clinical recurrence. An index mRS ≥ i2b is associated with surgical recurrence, an index mRS ≥ i1 is associated with clinical recurrence and i1 or i2b with progression to severe endoscopic recurrence. These results support tight monitoring of disease activity and treatment optimization in patients with ileal lesions, and a more conservative management in patients with anastomotic lesions. Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterolog.

Citation

Michiel T J Bak, Sebastiaan Ten Bokkel Huinink, Nicole S Erler, Alexander G L Bodelier, Gerard Dijkstra, Mariëlle J Romberg-Camps, Nanne K H de Boer, Frank Hoentjen, Laurents P S Stassen, Andrea E van der Meulen-de Jong, Rachel L West, Oddeke van Ruler, C Janneke van der Woude, Annemarie C de Vries, Dutch Initiative on Crohn and Colitis (ICC), Dutch Initiative on Crohn and Colitis (ICC). Prognostic value of the modified Rutgeerts' score for long-term outcomes after primary ileocecal resection in Crohn's disease. The American journal of gastroenterology. 2023 Sep 22

PMID: 37737675

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