Abstract Introduction Treatment strategies for Crohn disease (CD) have evolved considerably over recent decades. Approximately 65% of primary resections for CD comprise ileocolic resections (ICR). Currently, up-to-date data are not available on surgical recurrence risk after primary ICR, as previous meta-analyses combined various types of intestinal resections. As such, we aimed to assess the incidence, predictors, and trends of surgical recurrence after primary ICR for CD. Methods MEDLINE, EMBASE, and the Cochrane database were searched from inception until November 15, 2023. Studies were included if they described the surgical recurrence risk after a primary ICR for CD. The primary endpoint was surgical recurrence, defined as reoperation due to disease recurrence in the neoterminal ileum. Meta-analyses were performed to (1) evaluate trends in surgical recurrence over time, (2) estimate the risk of surgical recurrence in the biologics era (post-2000), and (3) identify risk factors for surgical recurrence. Results Among 3498 articles screened, 55 were included, of which 31 studies reported cumulative 5- and/or 10-year surgical recurrence rates (study inclusion period: 1932-2020; n = 28 354 patients). Meta-regression analysis indicated a declining trend in both 5- and 10-year surgical recurrence rates, which stabilized after 2000. In the biologics era, pooled 5- and 10-year surgical recurrence risks were 5.7% (95% CI, 3.9-8.4) and 13.0% (8.3-19.7), respectively. Smoking, patient sex, perianal disease, and behavior were not significantly prognostic for surgical recurrence after primary ICR. Conclusion Approximately 1 in 17 patients experience surgical recurrence within 5 years after primary ICR. The risk of surgical recurrence decreased over the past decades but has stabilized in the biologics era. Systematic Review Registration PROSPERO registration No. CRD42020213027.
Haanappel et al. (Fri,) studied this question.