Low Rates of Surgical Recurrence Following Ileocolic Resections for Crohn’s Disease in the Biologic Era

Hugh L. Giddings; Kheng Seong Ng; Michael J. Solomon; Arteen Arzivian; Craig Haifer; Huiyu Lin; Christian Pappas; David Clark; Anthony Deacon; Graham Radford-Smith; Nargus Ebrahimi; Ann Wu; Mark Lewis; Roscoe Lim; Jennifer Zhang; Abhinav Vasudevan; Kathryn Demase; Jadon Karp; Richard G. Fernandes; Yoon Kyo An; Zi Qin Ng; Scott Mackenzie; Lena Thin; Tessa Greeve; Gregory T. Moore; Susan J. Connor; Jane M. Andrews; Miles P. Sparrow; Simon Ghaly

doi:10.1093/ibd/izaf244

Low Rates of Surgical Recurrence Following Ileocolic Resections for Crohn’s Disease in the Biologic Era

Hugh L. Giddings
, Kheng Seong Ng
, Michael J. Solomon
, Arteen Arzivian
, Craig Haifer
, Huiyu Lin
, Christian Pappas
, David Clark
, Anthony Deacon
, Graham Radford-Smith
, Nargus Ebrahimi
, Ann Wu
, Mark Lewis
, Roscoe Lim
, Jennifer Zhang
, Abhinav Vasudevan
, Kathryn Demase
, Jadon Karp
, Richard G. Fernandes
, Yoon Kyo An

Zi Qin Ng, Scott Mackenzie, Lena Thin, Tessa Greeve, Gregory T. Moore, Susan J. Connor, Jane M. Andrews, Miles P. Sparrow, Simon Ghaly

Royal Prince Alfred Hospital
The University of Sydney
Concord Repatriation General Hospital
Department of Gastroenterology and Hepatology
University of New South Wales
Tan Tock Seng Hospital
Department of Surgery
University of Queensland
Royal Adelaide Hospital
Box Hill Hospital
Monash University
Alfred Health
Mater Group
Liverpool Hospital
Fiona Stanley Hospital
Monash Health
Liverpool Hospital
Crohn’s Colitis Cure (CCCure)
Adelaide University

Research output: Contribution to journal › Article › peer-review

Abstract

Background Ileocolic resections (ICRs) are the most common resections for Crohn’s disease. Historical control groups have often been used for comparison when assessing postoperative recurrence, usually with temporal bias. This study aimed to (1) report contemporary rates of postoperative recurrence requiring repeat surgery (surgical recurrence at anastomosis [surgical recurrence at the ileocolic resection site (SR-ICR)] or surgical recurrence at any site) and the rates of endoscopic recurrence (ER) in the “biologic era”; and (2) determine risk factors for SR-ICR and ER. Methods A retrospective multicenter study involving 12 tertiary Australian centers was performed. Patients (of any age) who had undergone an ICR for Crohn’s disease between 2007 and 2023 were included. Cox proportional hazards modeling was used to evaluate clinicopathological risk factors for SR-ICR and ER (defined as Rutgeerts grade ≥i2b). Results Overall, 875 patients were included (mean 38.7 ± 15.1 years, 51% female). Median follow-up was 63.9 months. Rates of SR-ICR were 4.5% (95% confidence interval [CI], 2.8%-6.1%) and 12.8% (95% CI, 8.8%-16.5%) at 5 and 10 years, respectively. Rates of surgical recurrence at any site were 5.6% (95% CI, 3.8%-7.5%) and 15.1% (95% CI, 11.0%-19.1%) at 5 and 10 years, respectively. Early (within 12 months) ER occurred in 24.7%. On multivariable analysis, smoking (adjusted hazard ratio, 3.49; 95% CI, 1.93-6.29) was the only factor significantly associated with SR-ICR. Smoking, positive microscopic margins, and granulomas were associated with ER, and prophylactic therapy and younger age at diagnosis (<17 years) were protective. Conclusions The rate of SR at the ileocolic anastomosis in this large Australian cohort was low, recorded to be 1 in 20 at 5 years. Smoking remains the strongest risk factor for both ER and SR. Histopathological factors influence ER and should be considered in future risk prediction models.

Original language	English
Pages (from-to)	421-432
Number of pages	12
Journal	Inflammatory Bowel Diseases
Volume	32
Issue number	3
DOIs	https://doi.org/10.1093/ibd/izaf244
Publication status	Published - 1 Mar 2026
Externally published	Yes

Bibliographical note

Publisher Copyright:
© The Author(s) 2025. Published by Oxford University Press on behalf of Crohn’s & Colitis Foundation.

Keywords

endoscopic recurrence
ileocolic resection
post operative recurrence
surgical recurrence

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10.1093/ibd/izaf244

Cite this

Giddings, H. L., Ng, K. S., Solomon, M. J., Arzivian, A., Haifer, C., Lin, H., Pappas, C., Clark, D., Deacon, A., Radford-Smith, G., Ebrahimi, N., Wu, A., Lewis, M., Lim, R., Zhang, J., Vasudevan, A., Demase, K., Karp, J., Fernandes, R. G., ... Ghaly, S. (2026). Low Rates of Surgical Recurrence Following Ileocolic Resections for Crohn’s Disease in the Biologic Era. Inflammatory Bowel Diseases, 32(3), 421-432. https://doi.org/10.1093/ibd/izaf244

@article{12020d3ec1b441f7a780b1cce0e71e7b,

title = "Low Rates of Surgical Recurrence Following Ileocolic Resections for Crohn{\textquoteright}s Disease in the Biologic Era",

abstract = "Background Ileocolic resections (ICRs) are the most common resections for Crohn{\textquoteright}s disease. Historical control groups have often been used for comparison when assessing postoperative recurrence, usually with temporal bias. This study aimed to (1) report contemporary rates of postoperative recurrence requiring repeat surgery (surgical recurrence at anastomosis [surgical recurrence at the ileocolic resection site (SR-ICR)] or surgical recurrence at any site) and the rates of endoscopic recurrence (ER) in the “biologic era”; and (2) determine risk factors for SR-ICR and ER. Methods A retrospective multicenter study involving 12 tertiary Australian centers was performed. Patients (of any age) who had undergone an ICR for Crohn{\textquoteright}s disease between 2007 and 2023 were included. Cox proportional hazards modeling was used to evaluate clinicopathological risk factors for SR-ICR and ER (defined as Rutgeerts grade ≥i2b). Results Overall, 875 patients were included (mean 38.7 ± 15.1 years, 51\% female). Median follow-up was 63.9 months. Rates of SR-ICR were 4.5\% (95\% confidence interval [CI], 2.8\%-6.1\%) and 12.8\% (95\% CI, 8.8\%-16.5\%) at 5 and 10 years, respectively. Rates of surgical recurrence at any site were 5.6\% (95\% CI, 3.8\%-7.5\%) and 15.1\% (95\% CI, 11.0\%-19.1\%) at 5 and 10 years, respectively. Early (within 12 months) ER occurred in 24.7\%. On multivariable analysis, smoking (adjusted hazard ratio, 3.49; 95\% CI, 1.93-6.29) was the only factor significantly associated with SR-ICR. Smoking, positive microscopic margins, and granulomas were associated with ER, and prophylactic therapy and younger age at diagnosis (<17 years) were protective. Conclusions The rate of SR at the ileocolic anastomosis in this large Australian cohort was low, recorded to be 1 in 20 at 5 years. Smoking remains the strongest risk factor for both ER and SR. Histopathological factors influence ER and should be considered in future risk prediction models.",

keywords = "endoscopic recurrence, ileocolic resection, post operative recurrence, surgical recurrence",

author = "Giddings, \{Hugh L.\} and Ng, \{Kheng Seong\} and Solomon, \{Michael J.\} and Arteen Arzivian and Craig Haifer and Huiyu Lin and Christian Pappas and David Clark and Anthony Deacon and Graham Radford-Smith and Nargus Ebrahimi and Ann Wu and Mark Lewis and Roscoe Lim and Jennifer Zhang and Abhinav Vasudevan and Kathryn Demase and Jadon Karp and Fernandes, \{Richard G.\} and An, \{Yoon Kyo\} and Ng, \{Zi Qin\} and Scott Mackenzie and Lena Thin and Tessa Greeve and Moore, \{Gregory T.\} and Connor, \{Susan J.\} and Andrews, \{Jane M.\} and Sparrow, \{Miles P.\} and Simon Ghaly",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2025. Published by Oxford University Press on behalf of Crohn{\textquoteright}s \& Colitis Foundation.",

year = "2026",

month = mar,

day = "1",

doi = "10.1093/ibd/izaf244",

language = "English",

volume = "32",

pages = "421--432",

journal = "Inflammatory Bowel Diseases",

issn = "1078-0998",

publisher = "Oxford University Press",

number = "3",

}

Giddings, HL, Ng, KS, Solomon, MJ, Arzivian, A, Haifer, C, Lin, H, Pappas, C, Clark, D, Deacon, A, Radford-Smith, G, Ebrahimi, N, Wu, A, Lewis, M, Lim, R, Zhang, J, Vasudevan, A, Demase, K, Karp, J, Fernandes, RG, An, YK, Ng, ZQ, Mackenzie, S, Thin, L, Greeve, T, Moore, GT, Connor, SJ, Andrews, JM, Sparrow, MP & Ghaly, S 2026, 'Low Rates of Surgical Recurrence Following Ileocolic Resections for Crohn’s Disease in the Biologic Era', Inflammatory Bowel Diseases, vol. 32, no. 3, pp. 421-432. https://doi.org/10.1093/ibd/izaf244

TY - JOUR

T1 - Low Rates of Surgical Recurrence Following Ileocolic Resections for Crohn’s Disease in the Biologic Era

AU - Giddings, Hugh L.

AU - Ng, Kheng Seong

AU - Solomon, Michael J.

AU - Arzivian, Arteen

AU - Haifer, Craig

AU - Lin, Huiyu

AU - Pappas, Christian

AU - Clark, David

AU - Deacon, Anthony

AU - Radford-Smith, Graham

AU - Ebrahimi, Nargus

AU - Wu, Ann

AU - Lewis, Mark

AU - Lim, Roscoe

AU - Zhang, Jennifer

AU - Vasudevan, Abhinav

AU - Demase, Kathryn

AU - Karp, Jadon

AU - Fernandes, Richard G.

AU - An, Yoon Kyo

AU - Ng, Zi Qin

AU - Mackenzie, Scott

AU - Thin, Lena

AU - Greeve, Tessa

AU - Moore, Gregory T.

AU - Connor, Susan J.

AU - Andrews, Jane M.

AU - Sparrow, Miles P.

AU - Ghaly, Simon

PY - 2026/3/1

Y1 - 2026/3/1

N2 - Background Ileocolic resections (ICRs) are the most common resections for Crohn’s disease. Historical control groups have often been used for comparison when assessing postoperative recurrence, usually with temporal bias. This study aimed to (1) report contemporary rates of postoperative recurrence requiring repeat surgery (surgical recurrence at anastomosis [surgical recurrence at the ileocolic resection site (SR-ICR)] or surgical recurrence at any site) and the rates of endoscopic recurrence (ER) in the “biologic era”; and (2) determine risk factors for SR-ICR and ER. Methods A retrospective multicenter study involving 12 tertiary Australian centers was performed. Patients (of any age) who had undergone an ICR for Crohn’s disease between 2007 and 2023 were included. Cox proportional hazards modeling was used to evaluate clinicopathological risk factors for SR-ICR and ER (defined as Rutgeerts grade ≥i2b). Results Overall, 875 patients were included (mean 38.7 ± 15.1 years, 51% female). Median follow-up was 63.9 months. Rates of SR-ICR were 4.5% (95% confidence interval [CI], 2.8%-6.1%) and 12.8% (95% CI, 8.8%-16.5%) at 5 and 10 years, respectively. Rates of surgical recurrence at any site were 5.6% (95% CI, 3.8%-7.5%) and 15.1% (95% CI, 11.0%-19.1%) at 5 and 10 years, respectively. Early (within 12 months) ER occurred in 24.7%. On multivariable analysis, smoking (adjusted hazard ratio, 3.49; 95% CI, 1.93-6.29) was the only factor significantly associated with SR-ICR. Smoking, positive microscopic margins, and granulomas were associated with ER, and prophylactic therapy and younger age at diagnosis (<17 years) were protective. Conclusions The rate of SR at the ileocolic anastomosis in this large Australian cohort was low, recorded to be 1 in 20 at 5 years. Smoking remains the strongest risk factor for both ER and SR. Histopathological factors influence ER and should be considered in future risk prediction models.

AB - Background Ileocolic resections (ICRs) are the most common resections for Crohn’s disease. Historical control groups have often been used for comparison when assessing postoperative recurrence, usually with temporal bias. This study aimed to (1) report contemporary rates of postoperative recurrence requiring repeat surgery (surgical recurrence at anastomosis [surgical recurrence at the ileocolic resection site (SR-ICR)] or surgical recurrence at any site) and the rates of endoscopic recurrence (ER) in the “biologic era”; and (2) determine risk factors for SR-ICR and ER. Methods A retrospective multicenter study involving 12 tertiary Australian centers was performed. Patients (of any age) who had undergone an ICR for Crohn’s disease between 2007 and 2023 were included. Cox proportional hazards modeling was used to evaluate clinicopathological risk factors for SR-ICR and ER (defined as Rutgeerts grade ≥i2b). Results Overall, 875 patients were included (mean 38.7 ± 15.1 years, 51% female). Median follow-up was 63.9 months. Rates of SR-ICR were 4.5% (95% confidence interval [CI], 2.8%-6.1%) and 12.8% (95% CI, 8.8%-16.5%) at 5 and 10 years, respectively. Rates of surgical recurrence at any site were 5.6% (95% CI, 3.8%-7.5%) and 15.1% (95% CI, 11.0%-19.1%) at 5 and 10 years, respectively. Early (within 12 months) ER occurred in 24.7%. On multivariable analysis, smoking (adjusted hazard ratio, 3.49; 95% CI, 1.93-6.29) was the only factor significantly associated with SR-ICR. Smoking, positive microscopic margins, and granulomas were associated with ER, and prophylactic therapy and younger age at diagnosis (<17 years) were protective. Conclusions The rate of SR at the ileocolic anastomosis in this large Australian cohort was low, recorded to be 1 in 20 at 5 years. Smoking remains the strongest risk factor for both ER and SR. Histopathological factors influence ER and should be considered in future risk prediction models.

KW - endoscopic recurrence

KW - ileocolic resection

KW - post operative recurrence

KW - surgical recurrence

UR - https://www.scopus.com/pages/publications/105031857130

U2 - 10.1093/ibd/izaf244

DO - 10.1093/ibd/izaf244

M3 - Article

C2 - 41332286

AN - SCOPUS:105031857130

SN - 1078-0998

VL - 32

SP - 421

EP - 432

JO - Inflammatory Bowel Diseases

JF - Inflammatory Bowel Diseases

IS - 3

ER -

Low Rates of Surgical Recurrence Following Ileocolic Resections for Crohn’s Disease in the Biologic Era

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