Recurrence rates following ileo-colic resection in pediatric patients with Crohn’s disease

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Shouval, Maya Paran, Manar Matar, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2213747/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 16 Jan, 2023 Read the published version in Pediatric Surgery International → Version 1 posted 7 You are reading this latest preprint version Abstract Background : Ileo-colic resection (ICR) is an important therapeutic option for Crohn’s disease (CD) patients. There is limited updated data of clinical and endoscopic post-operative recurrence (POR) in pediatric patients with CD for the long run. We aimed to determine recurrence rates following ICR over an extended period of time and asses its risk factors. Methods : This is a single-center retrospective review of 35 patients with CD between the ages of 6 to 17.9 years who required ICR between 2003 and 2021at Schneider Children Medical Center of Israel. Medical charts were reviewed at different time-points post-ICR. Results : Clinical recurrence following ICR was demonstrated in only 11.4% and 28.6% (n=4, n=10) in the first two and five years- much lower rates than what was reported so far. We found no specific risk factor that correlated with clinical recurrence, although patients that were treated with early prophylaxis of anti TNF medications following ICR tend to have less recurrence. Conclusions : We found lower POR following ICR, especially in the first years after surgery- which can be attributed to close surveillance and early medical treatment. Such surveillance seem to improve recurrence rates in the first years following ICR. ileo-cecal resection post-operative recurrence crohn's disease pediatric Introduction A significant number of adult and pediatric patients with Crohn’s disease (CD) present with terminal ileitis, and require immunosuppressive medications to control disease activity. Despite increasing numbers of medications, including different biologics, many patients fail to respond or lose response over time. Ileo-cecal resection (ICR) should be considered in CD patients with either fibrostenotic disease, medical refractory inflammatory disease or when local complications develop (fistulas and/or abscess formation). The surgical approach is often used when disease extent in the terminal ileum is not long, and offers an opportunity to remove diseased/inflamed segment, which allows to guide therapy to prevent recurrence after surgery, rather than treat an inflamed intestine. Laparoscopic assisted ileo-colonic resection is, in most of the cases, the standard surgical approach in recent years worldwide. It offers better visualization and faster recovery, as opposed to an open surgery that used to take place more than a decade ago. Post operative recurrence (POR) refers to “ de novo ” development of Crohn’s disease (CD) after a curative surgical intent (in which the macroscopic inflamed bowel is removed) [ ]. Clinical recurrence (i.e, reappearance of symptoms that indicate an active disease) and endoscopic recurrence (endoscopic lesions that are compatible with CD) can co-exist; however endoscopic recurrence tends to occur much earlier, sometimes even within weeks to months following surgery [ ]. Most of the risk factors regarding POR are based on adult studies, and include smoking, colonic inflammation or upper gastro-intestinal involvement. Data regarding POR in pediatric CD is broadly based on retrospective observational studies conducted more than 15 years ago, with high clinical recurrence rates in the first 1–2 years post ICR, reaching 55% [ - ]. When assessing endoscopy as an outcome, recurrence rates following ICR were even higher, suggesting that endoscopic inflammation might precede clinically active disease. Most recurrences, according to adult literature, occur in the 1st year after surgery (REF). Nevertheless, there is limited data on POR in pediatric patients. We aimed to investigate POR in the first 1,2,5 and 10 years following ICR in large pediatric hospital in Israel, and to assess risk factors that are associated with such recurrence. Methods A retrospective study was conducted that included data collection on all pediatric CD patients, aged 6-17.9 years, who underwent ICR between 2003 and 2021 in a tertiary pediatric center. We reviewed the medical charts for demographic and clinical data including age, gender, medical and surgical history. preoperative interventions (including administration of antibiotics, anti-TNF medications, immunomodulators, corticosteroids), preoperative nutritional support, surgical details and post operative course. We also assessed for long-term data, including follow-up visits, labs, endoscopies, post-operative medical therapy and assessment of clinical and endoscopic recurrence. For the current analysis we included patients that had at least 12 months of follow-up after ICR. Statistical analysis was performed using SAS/STAT software version 9.4 by Statistical Analysis System corporation, North Carolina, United States of America. Data were compared using Fisher’s exact test and χ2 to evaluate differences between qualitative variables and a t-test to compare quantitative variables. A P value of < 0.05 was considered significant. The study was approved by the local institutional review board committee. Results Overall, 38 patients with CD underwent laparoscopic assisted ileo-cecal resection at Schneider Children’s Medical Center of Israel between 2003–2021. Three patients were lost to follow up following surgery and were not included in our cohort (total of 35 patients). The cohort included 19 males (54.2%) and 16 females (45.7%) with a mean age of 15.11 years at time of surgery (range 10.0-17.8). The Mean interval between age at diagnosis and age at surgical intervention was 40.6 months (range 1-110 months, median- 40). Fourteen patients (40%) required special pre-operative management that took place during admission (pre-operative optimization, such as special enteral or parenteral nutrition, IV antibiotics or intra-abdominal percutaneous abscess drainage. in eight patients, severe fibro-stenotic disease and subsequent imminent obstruction were noted during colonoscopy, that necessitated special enteral and/or parenteral nutrition prior to ICR. In six patients, an intra-abdominal abscess was noted in CT scans, but only half of them (n = 3) necessitated percutaneous or laparoscopic intra-abdominal drainage. Details regarding pre-operative medical treatment is presented in Table 1 . Table 1: Demographic and pre-operative data: Characteristics Gender (M:F) 19:16 Age at diagnosis of CD (median, range) 12.3 (6.0, 17.5) Age at time of ICR (median, range) 15.1 (10-17.8) Time from initial diagnosis to surgery in months (range) 40.68 (1-110) Pre-operative steroids (n,%) 12 (34%) Pre-operative immune-modulators (n,%) 11(31.4%) Pre-operative anti TNFa (n,%) 21 (60%) Pre-operative enteral or parenteral nutrition (n,%) 18 (51.4%) Pre-operative IV antibiotics (n,%) 20 (57.14%) Pre- operative intra-abdominal abscess drainage 3 (8.57%) All patients underwent laparoscopic assisted ICR with primary anastomosis. 29 patients (82.8%) underwent stapled side to side anastomosis and the remaining 6 patients (17.1%) underwent hand sewn end to end anastomosis. Mean length of stay following surgery was 8.53 days. There were no post-operative complications, except in a single patient that developed wound infection and required wound exploration. The median follow-up of patients following ICR was 4.7 years. One patient died 15 years following initial surgery due to small bowel adenocarcinoma. Two more patients underwent a second surgical resection, 7 and 10 years following first surgery, respectively, due to active medical-refractory CD. All patients had close surveillance following ICR by pediatric gastroenterologists and pediatric surgeons. In all patients, a recommendation to start early prophylaxis (immunomodulators in the first years of our study or anti-TNF medications in recent years) was given, and in the past years a follow up colonoscopy was also part of the surveillance, usually in the first year to follow ICR. Median time of follow up was 4.5 years (min – 1 year, max- 16 years). Clinical recurrence was defined as recurrence of abdominal pain, diarrhea or fever lasting more than 2–3 weeks when an infectious process was ruled out. Out of 35 patients, 18 (51.4%) had recurrent symptoms during the study period, of whom 4 patients demonstrated clinical recurrence in the first two years (11.4%), and 10 patients (28.6%) in the first five years to follow. Endoscopic recurrence was defined during colonoscopy based on Rutgers score, including anastomotic aphthous lesions, ulcers or diffusely inflamed mucosa, with or without stenosis. In recent years a scheduled colonoscopy was planned in each patient, according to newer protocols. However, in earlier years colonoscopy was performed only after signs of clinical recurrence and/or laboratory results that demonstrated an active inflammatory process. In two patients an endoscopic recurrence was noted, although without clinical recurrence. Details regarding clinical and endoscopic recurrence are outlined in Table 2 : Table 2 Surgical data and post-operative long term follow up: Characteristic Clinical recurrence Endoscopic recurrence Recurrence in the 1st year following surgery 1 1 Recurrence 1–2 years following surgery 3 5 Recurrence 2–5 years following surgery 6 6 Recurrence 5–10 years following surgery 2 2 Recurrence 10 + years following surgery 6 6 Total no. of patients with recurrence 18 16 Table 3 outlines risk factors that may be associated with POR. In our cohort, patients that were treated immediately with anti-TNF medications tend to have lower recurrence rate, although not statistically significant. Other factors that were previously reported as risk factors (such as, young age at diagnosis or longer duration to surgery) were not statistically significant, in our cohort, as risk factors of post operative recurrence. Table 3 – risk factors associated with post operative recurrence: No Recurrence (n = 17) Recurrence (n = 18) p value Age at diagnosis (median, range) 13 (7, 15.3) 10 (6, 17.5) 0.64 Time (months) to surgery (median, range) 27 (1,110) 43 (3,104) 0.34 Anti-TNFa therapy following initial surgery 12 6 0.09 Follow up time in Years (average, range) 4.1 (1–12) 9.3 (2–16) 0.14 Discussion Ileo-colonic resection is the most frequent operation performed in CD patients [ ]. However, the term “curative resection” does not truly imply a definite cure, and many efforts have been made in the last decades in order maintain quiescent disease and postpone recurrence. Such efforts include early routine endoscopic monitoring (6–12 months following surgery) and/or early postoperative pharmacological prophylaxis [ ]. In the pediatric population, there is little up-to-date data on recurrence rates. The NASPGHAN Clinical Report on Postoperative Recurrence that was published in 2017 states that clinical recurrence is frequent, occurring in up to 55% in the first 1 to 2 years post surgery. Moreover, approximately 50–73% of patients had clinical recurrence by 5 and 10 years after surgery. However, the review was based on observations that were published more than a decade ago. Spencer et al. [ ] recently published updated data regarding pediatric endoscopic rate recurrence in the biological era and revealed that the rate of endoscopic recurrence was 46% at 2 years, demonstrating the need for postoperative surveillance and effective prophylaxis. The study also reinforces the findings that both younger age at diagnosis and longer disease duration in pediatric CD are associated with disease recurrence postoperatively [ ]. Nevertheless, the article focuses mainly on endoscopic and histological recurrence, and less on clinical recurrence and long term follow up. In the current study, we investigated long term follow up (median-4.5 years) post ICR in the pediatric population. We found that in the first two years following surgery, only 11.4% (n = 4) patients had clinical recurrence, much lower than what was reported so far. These findings shed new light and demonstrate potentially improved outcomes, especially in the first years to follow ICR. It can be attributed to both initiation of anti-TNF medications (shortly after ICR) and routine post op colonoscopy. In our cohort, 18 patients (51%) received early anti-TNFa medications following ICR, which is higher significantly than what was reported in other cohorts (0–10%) [6, ]. This likely represents a universal trend of initiation of early prophylaxis with anti-TNFa medications within several weeks of ICR [8]. We have noticed lower rates of recurrence in this group (33%/n = 6 compared to 64.7%/n = 11 in the group that had not receive such prophylaxis) but without statistical significance. It is possible that with larger numbers the true effects of early anti-TNFa prophylaxis following ICR would be evident. Albeit other reports precluded that younger age at diagnosis and longer duration to surgery as risk factors regarding POR, and although patients that had POR in our cohort tend to be younger at diagnosis and have longer duration to ICR, we did not identify these features as risk factors associated with POR. Although lower POR were observed in the first two years, when looking on long term follow up, half (n = 18/35) of the patients had clinical recurrence. Such rates need to be revised in the years to come when more data will be available on patients that were operated in the last 1–3 years. Our paper has several limitations. First, this is a retrospective study. Second, patients that underwent ICR more than a decade ago were compared to patients that underwent more recent procedures, when close surveillance practices were applied. However, it demonstrates a clear trend and a better benchmark to set upon when dealing with POR in the pediatric population. In conclusion, the combination of performing ICR and continue with close surveillance that includes early anti – TNF prophylaxis and a scheduled colonoscopy yielded, in the last years, much lower POR. Such results are critical in terms of growth and development in children suffering from crohn’s disease. Declarations Statement of ethics : This study was approved by the local ethics committee at Rabin Medical Center. Disclosure statement: The authors declare that they have no conflict of interest. Funding source: none. References Markowitz J, Markowitz JE, Bousvaros A, et al. Workshop report: prevention of postoperative recurrence in Crohn’s disease. J Pediatr Gastroenterol Nutr 2005;41:145–51 De Cruz P, Kamm MA, Prideaux L, et al. Postoperative recurrent luminal Crohn’s disease: a systematic review. Inflamm Bowel Dis 2012;18:758–77. Baldassano RN, Han PD, Jeshion WC, et al. Pediatric Crohn’s disease: risk factors for postoperative recurrence. Am J Gastroenterol 2001;96:2169–76. Piekkala M, Pakarinen M, Ashorn M, et al. Long-term outcomes after surgery on pediatric patients with Crohn disease. J Pediatr Gastroenterol Nutr 2013;56:271–6. H. Yanai, A Kagrammanova, O. Knyazev, J. Sabino et al: Endoscopic postoperative recurrence in crohn’s disease after curative ileocecal resection with early prophylaxis by anti -TNF, Vedolizumab or Ustekinumab: a real world multicenter European study, 2022 Jul 27; jjac100. doi: 10.1093/ecco-jcc/jjac100 Regueiro M, Velayos F, Greer JB, et al. American gastroenterological association institute technical review on the management of crohn's disease after surgical resection. Gastroenterology 2017. Elizabeth A Spencer , Lauren Jarchin , Priya Rolfes , Sergey Khaitov , Alexander Greenstein , Marla C Dubinsky: Outcomes of Primary Ileocolic Resection for Pediatric Crohn Disease in the Biologic Era, J Pediatr Gastroenterol Nutr, 2021 Dec 1;73(6):710-716. Christensen B, Erlich J, Gibson PR, et al. Histologic healing is more strongly associated with clinical outcomes in ileal Crohn's disease than endoscopic healing. Clin Gastroenterol Hepatol 2020; 18:2518.e1–2525.e1. Diederen K, de Ridder L, van Rheenen P, et al. Complications and disease recurrence after primary ileocecal resection in pediatric Crohn’s disease: a multicenter cohort analysis. Inflamm Bowel Dis 2017;23:272–82. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 16 Jan, 2023 Read the published version in Pediatric Surgery International → Version 1 posted Editorial decision: Major revision 23 Nov, 2022 Reviews received at journal 15 Nov, 2022 Reviewers agreed at journal 06 Nov, 2022 Reviewers invited by journal 06 Nov, 2022 Editor assigned by journal 29 Oct, 2022 Submission checks completed at journal 29 Oct, 2022 First submitted to journal 28 Oct, 2022 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2213747","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":147868410,"identity":"4b42d0be-4f53-450a-a937-8353814effc8","order_by":0,"name":"Yael Dreznik","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8klEQVRIiWNgGAWjYHACxgMMbGC6meEDkGJjJ0IPXAvjDJAWZuK1MDAz84ApAsoNjh8+cICh7J6c/OzmZmObX9vk+ZgZGD98zMGj5UxawgGGc8XGjHMONifn9t02bGNmYJacuQ2PlgM5BgcY2xISmyUSmw/n9txmBGphY+bFp+X8+w8gLfVtIC2WPbftCWu5kcMA0pLAA9SSzPDjdiJBLZI3nhkcSDiXYDgDqMWwt+F2chszYzNev/CdT3744ENZgrz8jPTHEj/+3Lad39588MNHPFoUDgCJBBiPsQ1MNuBWDwTyqNJ/8CoeBaNgFIyCEQoAI71UNIlbPEEAAAAASUVORK5CYII=","orcid":"","institution":"","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Yael","middleName":"","lastName":"Dreznik","suffix":""},{"id":147868411,"identity":"86261f0f-abbd-4624-a5e0-b5f08e022598","order_by":1,"name":"Inbal Samuk","email":"","orcid":"","institution":"","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Inbal","middleName":"","lastName":"Samuk","suffix":""},{"id":147868412,"identity":"173c8a38-7d8e-41bb-8d60-6ff378c4f10e","order_by":2,"name":"Dror S. 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Despite increasing numbers of medications, including different biologics, many patients fail to respond or lose response over time. Ileo-cecal resection (ICR) should be considered in CD patients with either fibrostenotic disease, medical refractory inflammatory disease or when local complications develop (fistulas and/or abscess formation). The surgical approach is often used when disease extent in the terminal ileum is not long, and offers an opportunity to remove diseased/inflamed segment, which allows to guide therapy to prevent recurrence after surgery, rather than treat an inflamed intestine.\u003c/p\u003e \u003cp\u003eLaparoscopic assisted ileo-colonic resection is, in most of the cases, the standard surgical approach in recent years worldwide. It offers better visualization and faster recovery, as opposed to an open surgery that used to take place more than a decade ago.\u003c/p\u003e \u003cp\u003ePost operative recurrence (POR) refers to \u0026ldquo;\u003cem\u003ede novo\u003c/em\u003e\u0026rdquo; development of Crohn\u0026rsquo;s disease (CD) after a curative surgical intent (in which the macroscopic inflamed bowel is removed) [\u003ca class=\"FNLink\" href=\"#Fn1\" id=\"#FNLinkFn1\"\u003e\u003c/a\u003e]. Clinical recurrence (i.e, reappearance of symptoms that indicate an active disease) and endoscopic recurrence (endoscopic lesions that are compatible with CD) can co-exist; however endoscopic recurrence tends to occur much earlier, sometimes even within weeks to months following surgery [\u003ca class=\"FNLink\" href=\"#Fn2\" id=\"#FNLinkFn2\"\u003e\u003c/a\u003e]. Most of the risk factors regarding POR are based on adult studies, and include smoking, colonic inflammation or upper gastro-intestinal involvement. Data regarding POR in pediatric CD is broadly based on retrospective observational studies conducted more than 15 years ago, with high clinical recurrence rates in the first 1\u0026ndash;2 years post ICR, reaching 55% [\u003ca class=\"FNLink\" href=\"#Fn3\" id=\"#FNLinkFn3\"\u003e\u003c/a\u003e-\u003ca class=\"FNLink\" href=\"#Fn4\" id=\"#FNLinkFn4\"\u003e\u003c/a\u003e]. When assessing endoscopy as an outcome, recurrence rates following ICR were even higher, suggesting that endoscopic inflammation might precede clinically active disease. Most recurrences, according to adult literature, occur in the 1st year after surgery (REF). Nevertheless, there is limited data on POR in pediatric patients. We aimed to investigate POR in the first 1,2,5 and 10 years following ICR in large pediatric hospital in Israel, and to assess risk factors that are associated with such recurrence.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eA retrospective study was conducted that included data collection on all pediatric CD patients, aged 6-17.9 years, who underwent ICR between 2003 and 2021 in a tertiary pediatric center. We reviewed the medical charts for demographic and clinical data including age, gender, medical and surgical history. preoperative interventions (including administration of antibiotics, anti-TNF medications, immunomodulators, corticosteroids), preoperative nutritional support, surgical details and post operative course. We also assessed for long-term data, including follow-up visits, labs, endoscopies, post-operative medical therapy and assessment of clinical and endoscopic recurrence. For the current analysis we included patients that had at least 12 months of follow-up after ICR.\u003c/p\u003e \u003cp\u003eStatistical analysis was performed using SAS/STAT software version 9.4 by Statistical Analysis System corporation, North Carolina, United States of America. Data were compared using Fisher\u0026rsquo;s exact test and χ2 to evaluate differences between qualitative variables and a t-test to compare quantitative variables. A P value of \u0026lt;\u0026thinsp;0.05 was considered significant. The study was approved by the local institutional review board committee.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eOverall, 38 patients with CD underwent laparoscopic assisted ileo-cecal resection at Schneider Children\u0026rsquo;s Medical Center of Israel between 2003\u0026ndash;2021. Three patients were lost to follow up following surgery and were not included in our cohort (total of 35 patients). The cohort included 19 males (54.2%) and 16 females (45.7%) with a mean age of 15.11 years at time of surgery (range 10.0-17.8). The Mean interval between age at diagnosis and age at surgical intervention was 40.6 months (range 1-110 months, median- 40).\u003c/p\u003e \u003cp\u003eFourteen patients (40%) required special pre-operative management that took place during admission (pre-operative optimization, such as special enteral or parenteral nutrition, IV antibiotics or intra-abdominal percutaneous abscess drainage. in eight patients, severe fibro-stenotic disease and subsequent imminent obstruction were noted during colonoscopy, that necessitated special enteral and/or parenteral nutrition prior to ICR. In six patients, an intra-abdominal abscess was noted in CT scans, but only half of them (n\u0026thinsp;=\u0026thinsp;3) necessitated percutaneous or laparoscopic intra-abdominal drainage.\u003c/p\u003e \u003cp\u003eDetails regarding pre-operative medical treatment is presented in \u003cb\u003eTable\u0026nbsp;1\u003c/b\u003e.\u003c/p\u003e \u003cp\u003e\u003cstrong\u003eTable 1: Demographic and pre-operative data:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"74.949083503055%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.05091649694501%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"100%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"74.949083503055%\"\u003e\n \u003cp\u003eGender (M:F)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.05091649694501%\"\u003e\n \u003cp\u003e19:16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"74.949083503055%\"\u003e\n \u003cp\u003eAge at diagnosis of CD (median, range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.05091649694501%\"\u003e\n \u003cp\u003e12.3 (6.0, 17.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"74.949083503055%\"\u003e\n \u003cp\u003eAge at time of ICR (median, range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.05091649694501%\"\u003e\n \u003cp\u003e15.1 (10-17.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"74.949083503055%\"\u003e\n \u003cp\u003eTime from initial diagnosis to surgery in months (range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.05091649694501%\"\u003e\n \u003cp\u003e40.68 (1-110)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"74.949083503055%\"\u003e\n \u003cp\u003ePre-operative steroids (n,%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.05091649694501%\"\u003e\n \u003cp\u003e12 (34%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"74.949083503055%\"\u003e\n \u003cp\u003ePre-operative immune-modulators (n,%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.05091649694501%\"\u003e\n \u003cp\u003e11(31.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"74.949083503055%\"\u003e\n \u003cp\u003ePre-operative anti TNFa (n,%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.05091649694501%\"\u003e\n \u003cp\u003e21 (60%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"74.949083503055%\"\u003e\n \u003cp\u003ePre-operative enteral or parenteral nutrition (n,%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.05091649694501%\"\u003e\n \u003cp\u003e18 (51.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"74.949083503055%\"\u003e\n \u003cp\u003ePre-operative IV antibiotics (n,%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.05091649694501%\"\u003e\n \u003cp\u003e20 (57.14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"74.949083503055%\"\u003e\n \u003cp\u003ePre- operative intra-abdominal abscess drainage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.05091649694501%\"\u003e\n \u003cp\u003e3 (8.57%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\u003cbr\u003e\n\u003cp\u003eAll patients underwent laparoscopic assisted ICR with primary anastomosis. 29 patients (82.8%) underwent stapled side to side anastomosis and the remaining 6 patients (17.1%) underwent hand sewn end to end anastomosis.\u003c/p\u003e \u003cp\u003eMean length of stay following surgery was 8.53 days. There were no post-operative complications, except in a single patient that developed wound infection and required wound exploration. The median follow-up of patients following ICR was 4.7 years. One patient died 15 years following initial surgery due to small bowel adenocarcinoma. Two more patients underwent a second surgical resection, 7 and 10 years following first surgery, respectively, due to active medical-refractory CD.\u003c/p\u003e \u003cp\u003eAll patients had close surveillance following ICR by pediatric gastroenterologists and pediatric surgeons. In all patients, a recommendation to start early prophylaxis (immunomodulators in the first years of our study or anti-TNF medications in recent years) was given, and in the past years a follow up colonoscopy was also part of the surveillance, usually in the first year to follow ICR. Median time of follow up was 4.5 years (min \u0026ndash; 1 year, max- 16 years).\u003c/p\u003e \u003cp\u003eClinical recurrence was defined as recurrence of abdominal pain, diarrhea or fever lasting more than 2\u0026ndash;3 weeks when an infectious process was ruled out. Out of 35 patients, 18 (51.4%) had recurrent symptoms during the study period, of whom 4 patients demonstrated clinical recurrence in the first two years (11.4%), and 10 patients (28.6%) in the first five years to follow.\u003c/p\u003e \u003cp\u003eEndoscopic recurrence was defined during colonoscopy based on Rutgers score, including anastomotic aphthous lesions, ulcers or diffusely inflamed mucosa, with or without stenosis. In recent years a scheduled colonoscopy was planned in each patient, according to newer protocols. However, in earlier years colonoscopy was performed only after signs of clinical recurrence and/or laboratory results that demonstrated an active inflammatory process. In two patients an endoscopic recurrence was noted, although without clinical recurrence. Details regarding clinical and endoscopic recurrence are outlined in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e2\u003c/span\u003e:\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSurgical data and post-operative long term follow up:\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClinical recurrence\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEndoscopic recurrence\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRecurrence in the 1st year following surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRecurrence 1\u0026ndash;2 years following surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRecurrence 2\u0026ndash;5 years following surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRecurrence 5\u0026ndash;10 years following surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRecurrence 10\u0026thinsp;+\u0026thinsp;years following surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal no. of patients with recurrence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e outlines risk factors that may be associated with POR. In our cohort, patients that were treated immediately with anti-TNF medications tend to have lower recurrence rate, although not statistically significant. Other factors that were previously reported as risk factors (such as, young age at diagnosis or longer duration to surgery) were not statistically significant, in our cohort, as risk factors of post operative recurrence.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u0026ndash; risk factors associated with post operative recurrence:\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo Recurrence (n\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRecurrence (n\u0026thinsp;=\u0026thinsp;18)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge at diagnosis (median, range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (7, 15.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (6, 17.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime (months) to surgery (median, range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27 (1,110)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43 (3,104)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnti-TNFa therapy following initial surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFollow up time in Years (average, range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.1 (1\u0026ndash;12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.3 (2\u0026ndash;16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIleo-colonic resection is the most frequent operation performed in CD patients [\u003ca class=\"FNLink\" href=\"#Fn5\" id=\"#FNLinkFn5\"\u003e\u003c/a\u003e]. However, the term \u0026ldquo;curative resection\u0026rdquo; does not truly imply a definite cure, and many efforts have been made in the last decades in order maintain quiescent disease and postpone recurrence. Such efforts include early routine endoscopic monitoring (6\u0026ndash;12 months following surgery) and/or early postoperative pharmacological prophylaxis [\u003ca class=\"FNLink\" href=\"#Fn6\" id=\"#FNLinkFn6\"\u003e\u003c/a\u003e]. In the pediatric population, there is little up-to-date data on recurrence rates.\u003c/p\u003e \u003cp\u003eThe NASPGHAN Clinical Report on Postoperative Recurrence that was published in 2017 states that clinical recurrence is frequent, occurring in up to 55% in the first 1 to 2 years post surgery. Moreover, approximately 50\u0026ndash;73% of patients had clinical recurrence by 5 and 10 years after surgery. However, the review was based on observations that were published more than a decade ago. Spencer et al. [\u003ca class=\"FNLink\" href=\"#Fn7\" id=\"#FNLinkFn7\"\u003e\u003c/a\u003e] recently published updated data regarding pediatric endoscopic rate recurrence in the biological era and revealed that the rate of endoscopic recurrence was 46% at 2 years, demonstrating the need for postoperative surveillance and effective prophylaxis. The study also reinforces the findings that both younger age at diagnosis and longer disease duration in pediatric CD are associated with disease recurrence postoperatively [\u003ca class=\"FNLink\" href=\"#Fn8\" id=\"#FNLinkFn8\"\u003e\u003c/a\u003e]. Nevertheless, the article focuses mainly on endoscopic and histological recurrence, and less on clinical recurrence and long term follow up.\u003c/p\u003e \u003cp\u003eIn the current study, we investigated long term follow up (median-4.5 years) post ICR in the pediatric population. We found that in the first two years following surgery, only 11.4% (n\u0026thinsp;=\u0026thinsp;4) patients had clinical recurrence, much lower than what was reported so far. These findings shed new light and demonstrate potentially improved outcomes, especially in the first years to follow ICR. It can be attributed to both initiation of anti-TNF medications (shortly after ICR) and routine post op colonoscopy.\u003c/p\u003e \u003cp\u003eIn our cohort, 18 patients (51%) received early anti-TNFa medications following ICR, which is higher significantly than what was reported in other cohorts (0\u0026ndash;10%) [6,\u003ca class=\"FNLink\" href=\"#Fn9\" id=\"#FNLinkFn9\"\u003e\u003c/a\u003e]. This likely represents a universal trend of initiation of early prophylaxis with anti-TNFa medications within several weeks of ICR [8]. We have noticed lower rates of recurrence in this group (33%/n\u0026thinsp;=\u0026thinsp;6 compared to 64.7%/n\u0026thinsp;=\u0026thinsp;11 in the group that had not receive such prophylaxis) but without statistical significance. It is possible that with larger numbers the true effects of early anti-TNFa prophylaxis following ICR would be evident.\u003c/p\u003e \u003cp\u003eAlbeit other reports precluded that younger age at diagnosis and longer duration to surgery as risk factors regarding POR, and although patients that had POR in our cohort tend to be younger at diagnosis and have longer duration to ICR, we did not identify these features as risk factors associated with POR.\u003c/p\u003e \u003cp\u003eAlthough lower POR were observed in the first two years, when looking on long term follow up, half (n\u0026thinsp;=\u0026thinsp;18/35) of the patients had clinical recurrence. Such rates need to be revised in the years to come when more data will be available on patients that were operated in the last 1\u0026ndash;3 years.\u003c/p\u003e \u003cp\u003eOur paper has several limitations. First, this is a retrospective study. Second, patients that underwent ICR more than a decade ago were compared to patients that underwent more recent procedures, when close surveillance practices were applied. However, it demonstrates a clear trend and a better benchmark to set upon when dealing with POR in the pediatric population.\u003c/p\u003e \u003cp\u003eIn conclusion, the combination of performing ICR and continue with close surveillance that includes early anti \u0026ndash; TNF prophylaxis and a scheduled colonoscopy yielded, in the last years, much lower POR. Such results are critical in terms of growth and development in children suffering from crohn\u0026rsquo;s disease.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eStatement of ethics\u003c/strong\u003e:\u0026nbsp;This study was approved by the local ethics committee at Rabin Medical Center.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclosure statement:\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding source:\u003c/strong\u003e none.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eMarkowitz J, Markowitz JE, Bousvaros A, et al. Workshop report: prevention of postoperative recurrence in Crohn\u0026rsquo;s disease. J Pediatr Gastroenterol Nutr 2005;41:145\u0026ndash;51\u003c/li\u003e\n \u003cli\u003eDe Cruz P, Kamm MA, Prideaux L, et al. Postoperative recurrent luminal Crohn\u0026rsquo;s disease: a systematic review. Inflamm Bowel Dis 2012;18:758\u0026ndash;77.\u003c/li\u003e\n \u003cli\u003eBaldassano RN, Han PD, Jeshion WC, et al. Pediatric Crohn\u0026rsquo;s disease: risk factors for postoperative recurrence. Am J Gastroenterol 2001;96:2169\u0026ndash;76.\u003c/li\u003e\n \u003cli\u003ePiekkala M, Pakarinen M, Ashorn M, et al. Long-term outcomes after surgery on pediatric patients with Crohn disease. J Pediatr Gastroenterol Nutr 2013;56:271\u0026ndash;6.\u003c/li\u003e\n \u003cli\u003eH. Yanai, A Kagrammanova, O. Knyazev, J. Sabino et al: Endoscopic postoperative recurrence in crohn\u0026rsquo;s disease after curative ileocecal resection with early prophylaxis by anti -TNF, Vedolizumab or Ustekinumab: a real world multicenter European study, 2022 Jul 27; jjac100. doi: 10.1093/ecco-jcc/jjac100\u003c/li\u003e\n \u003cli\u003eRegueiro M, Velayos F, Greer JB, et al. American gastroenterological association institute technical review on the management of crohn\u0026apos;s disease after surgical resection. Gastroenterology 2017.\u003c/li\u003e\n \u003cli\u003eElizabeth A Spencer , Lauren Jarchin , Priya Rolfes , Sergey Khaitov , Alexander Greenstein , Marla C Dubinsky: Outcomes of Primary Ileocolic Resection for Pediatric Crohn Disease in the Biologic Era, J Pediatr Gastroenterol Nutr, 2021 Dec 1;73(6):710-716.\u003c/li\u003e\n \u003cli\u003eChristensen B, Erlich J, Gibson PR, et al. Histologic healing is more strongly associated with clinical outcomes in ileal Crohn\u0026apos;s disease than endoscopic healing. Clin Gastroenterol Hepatol 2020; 18:2518.e1\u0026ndash;2525.e1.\u003c/li\u003e\n \u003cli\u003eDiederen K, de Ridder L, van Rheenen P, et al. Complications and disease recurrence after primary ileocecal resection in pediatric Crohn\u0026rsquo;s disease: a multicenter cohort analysis. Inflamm Bowel Dis 2017;23:272\u0026ndash;82.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"pediatric-surgery-international","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pesi","sideBox":"Learn more about [Pediatric Surgery International](http://link.springer.com/journal/383)","snPcode":"383","submissionUrl":"https://submission.nature.com/new-submission/383/3","title":"Pediatric Surgery International","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"ileo-cecal resection, post-operative recurrence, crohn's disease, pediatric","lastPublishedDoi":"10.21203/rs.3.rs-2213747/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2213747/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Ileo-colic resection (ICR) is an important therapeutic option for Crohn’s disease (CD) patients. There is limited updated data of clinical and endoscopic post-operative recurrence (POR) in pediatric patients with CD for the long run. We aimed to determine recurrence rates following ICR over an extended period of time and asses its risk factors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: This is a single-center retrospective review of 35 patients with CD between the ages of 6 to 17.9 years who required ICR between 2003 and 2021at Schneider Children Medical Center of Israel. Medical charts were reviewed at different time-points post-ICR.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eClinical recurrence following ICR was demonstrated in only 11.4% and 28.6% (n=4, n=10) in the first two and five years- much lower rates than what was reported so far. We found no specific risk factor that correlated with clinical recurrence, although patients that were treated with early prophylaxis of anti TNF medications following ICR tend to have less recurrence.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eWe found lower POR following ICR, especially in the first years after surgery- which can be attributed to close surveillance and early medical treatment. Such surveillance seem to improve recurrence rates in the first years following ICR.\u003c/p\u003e","manuscriptTitle":"Recurrence rates following ileo-colic resection in pediatric patients with Crohn’s disease","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-11-01 20:05:18","doi":"10.21203/rs.3.rs-2213747/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2022-11-23T16:59:10+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2022-11-15T18:31:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"6a3d6ad0-0d14-4fdb-8196-a45c14535c9e","date":"2022-11-06T21:32:44+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2022-11-06T19:39:19+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2022-10-29T11:20:40+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2022-10-29T10:52:29+00:00","index":"","fulltext":""},{"type":"submitted","content":"Pediatric Surgery International","date":"2022-10-28T12:26:08+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"pediatric-surgery-international","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pesi","sideBox":"Learn more about [Pediatric Surgery International](http://link.springer.com/journal/383)","snPcode":"383","submissionUrl":"https://submission.nature.com/new-submission/383/3","title":"Pediatric Surgery International","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"d556b3eb-fd8c-4178-8b37-4d207d84cc7d","owner":[],"postedDate":"November 1st, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2023-10-16T18:34:04+00:00","versionOfRecord":{"articleIdentity":"rs-2213747","link":"https://doi.org/10.1007/s00383-022-05346-1","journal":{"identity":"pediatric-surgery-international","isVorOnly":false,"title":"Pediatric Surgery International"},"publishedOn":"2023-01-16 18:24:05","publishedOnDateReadable":"January 16th, 2023"},"versionCreatedAt":"2022-11-01 20:05:18","video":"","vorDoi":"10.1007/s00383-022-05346-1","vorDoiUrl":"https://doi.org/10.1007/s00383-022-05346-1","workflowStages":[]},"version":"v1","identity":"rs-2213747","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2213747","identity":"rs-2213747","version":["v1"]},"buildId":"cBFmMYwuxLRRLfASyISRj","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}