イタバシ　ミチオ   Itabashi Michio   板橋　道朗    所属   医学部 医学科（東京女子医科大学病院）    職種   特任教授
論文種別	原著
言語種別	英語
査読の有無	査読なし
表題	Rate of Reoperation Decreased Significantly After Year 2002 in Patients With Crohn's Disease.
掲載誌名	正式名：Clinical gastroenterology and hepatology 略　 称：Clin Gastroenterol Hepatol ISSNコード：15427714/15423565
掲載区分	国外
巻・号・頁	18(4),pp.898-907
著者・共著者	Shinagawa Takahide, Hata Keisuke, Ikeuchi Hiroki, Fukushima Kouhei, Futami Kitaro, Sugita Akira, Uchino Motoi, Watanabe Kazuhiro, Higashi Daijiro, Kimura Hideaki, Araki Toshimitsu, Mizushima Tsunekazu, Itabashi Michio, Ueda Takeshi, Koganei Kazutaka, Oba Koji, Ishihara Soichiro, Suzuki Yasuo
発行年月	2020/04
概要	BACKGROUND & AIMS:Patients with Crohn's disease (CD) can require multiple intestinal surgeries. We examined time trends and risk factors for reoperation in patients with CD who underwent intestinal surgery, focusing on the effects of postoperative medical treatments.METHODS:We performed a retrospective analysis of 1871 patients with CD who underwent initial intestinal resection at 10 tertiary care institutions in Japan, with an initial surgical date after May 1982. We collected data on the background characteristics of all patients, including Montreal Classification, smoking status, and medical therapy after surgery (tumor necrosis factor antagonists [anti-TNF] agents or immunomodulators). The primary outcome was requirement for first reoperation. Rate of reoperation was estimated using the Kaplan-Meier method, and risk factors for reoperation were identified using the Cox regression model.RESULTS:The overall cumulative 5- and 10-year reoperation rates were 23.4% and 48.0%, respectively. Multivariable analysis showed that patients who underwent the initial surgery after May 2002 had a significantly lower rate of reoperation than patients who underwent surgery before April 2002 (hazard ratio [HR], 0.72; 95% CI, 0.61-0.86). Preoperative smoking (HR, 1.40; 95% CI, 1.18-1.68), perianal disease (HR, 1.50; 95% CI, 1.27-1.77), and ileocolic type of CD (HR, 1.42; 95% CI, 1.20-1.69) were significant risk factors for reoperation. Postoperative use of immunomodulators (HR, 0.60; 95% CI, 0.44-0.81) and anti-TNF therapy (HR, 0.71; 95% CI, 0.57-0.88) significantly reduced the risk. Anti-TNF was effective in the bionaive subgroup.CONCLUSIONS:The rate of reoperation in patients with CD significantly decreased after May 2002. Postoperative use of anti-TNF agents might reduce the reoperation rate for bionaive patients with CD.
DOI	10.1016/j.cgh.2019.07.025
PMID	31336198