High Endoscopic Recurrence Rates Seen After Segmental Colectomy in Crohn’s Disease
Segmental colectomy (SC) for Crohn’s disease (CD) is frequently performed to preserve uninvolved colonic segments, but postoperative recurrence remains common, according to a multicenter retrospective study examining long-term outcomes after surgery.
Investigators analyzed outcomes from 108 patients with CD who underwent SC between 2000 and 2019 at 3 tertiary inflammatory bowel disease referral centers. Postoperative recurrence was assessed by colonoscopy, with endoscopic recurrence defined as the presence of ulcers in the remaining colon.
Overall, 69 patients (63.9%) developed postoperative endoscopic recurrence, underscoring the high risk of disease reactivation even after limited colonic resection. Several patient- and disease-related factors were associated with increased recurrence risk. Patients younger than 40 years at the time of surgery and those with a disease duration of 156 months or less were significantly more likely to experience recurrence. In multivariable analysis, shorter disease duration remained an independent predictor of recurrence.
In contrast, certain surgical and treatment factors were associated with lower recurrence risk. Abdominal perineal resection and SC performed for malignancy were both linked to reduced likelihood of postoperative recurrence. Importantly, postoperative prophylactic use of tumor necrosis factor α (TNFα) inhibitors was associated with a significantly lower risk of endoscopic recurrence, even after adjustment for other variables.
The authors concluded that “although high rates of recurrence persist within the postoperative phase of SC for CD,” targeted medical strategies may improve outcomes. They emphasized that “the postoperative use of TNFα inhibitor for prophylactic purposes for a subset of patients may promote a more durable endoscopic remission.”
For gastroenterologists, the key takeaway is that SC does not eliminate the risk of Crohn’s disease recurrence, particularly in younger patients and those earlier in their disease course. Early postoperative surveillance remains essential, and selective use of TNFα inhibitor prophylaxis should be considered in patients at higher risk for recurrence to help preserve long-term colonic health.
Reference
Salem G, Bouvette CA, Hernandez-Rocha C, et al. Disease outcomes after segmental resection of colonic Crohn's disease: a retrospective multicenter study. Inflamm Bowel Dis. Published online December 22, 2025. doi:10.1093/ibd/izaf252
