{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T23:54:52Z","timestamp":1788393292410,"version":"build-2803163510"},"reference-count":46,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2024,4,14]],"date-time":"2024-04-14T00:00:00Z","timestamp":1713052800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Few data are available addressing the impact of post\u2010operative management of Crohn's disease (CD) on long\u2010term clinical course.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To assess the evolution of post\u2010operative management strategies over the last 40\u2009years and their impact on the re\u2010operation rate of CD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We included 657 patients with CD who had undergone their first radical ileo\u2010caecal resection between 1980 and 2020. Three cohorts were defined according to year of surgery: cohort 1 (1980\u20131998; <jats:italic>n<\/jats:italic>\u2009=\u2009198), cohort 2 (1999\u20132009; <jats:italic>n<\/jats:italic>\u2009=\u2009218) and cohort 3 (2010\u20132020; <jats:italic>n<\/jats:italic>\u2009=\u2009241). We estimated exposure to immunomodulators and anti\u2010TNF\u03b1 agents after surgery and rates of re\u2010operation using Kaplan\u2013Meier survival analyses. We used Cox proportional hazards regression to assess the association of clinical variables with time to re\u2010operation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Immunosuppressants, (IMMs) and anti\u2010TNF\u03b1 exposure within 5\u2009years after surgery increased significantly from cohort 1 to cohort 2 and cohort 3 (IMMs: 1.6%, 38.2% and 28.0%, respectively, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001; anti\u2010TNF\u03b1: 0.0%, 20.7% and 52.0%, respectively, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). There was no significant difference across cohorts regarding the cumulative probability of re\u2010operation within 5 and 10\u2009years. Multivariate analysis identified IMMs\/anti\u2010TNF\u03b1 exposure before the first surgery (HR 9.15; 95% CI 2.77\u201330.21) and post\u2010operatively (HR: 0.24; 95% CI 0.07\u20130.74) as variables associated with the risk of re\u2010operation. However, these associations had a time\u2010varying effect and become non\u2010significant after 5 and 2\u2009years after surgery, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Despite increased post\u2010operative use of IMMs and anti\u2010TNF\u03b1 agents in the last two decades, the impact of these strategies on the risk of long\u2010term re\u2010operation rate has been modest.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.18001","type":"journal-article","created":{"date-parts":[[2024,4,15]],"date-time":"2024-04-15T05:21:17Z","timestamp":1713158477000},"page":"1579-1588","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Crohn's disease after surgery: Changes in post\u2010operative management strategies over time and their impact on long\u2010term re\u2010operation rate\u2014A retrospective multicentre real\u2010world study"],"prefix":"10.1111","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8816-6950","authenticated-orcid":false,"given":"Annalisa","family":"Aratari","sequence":"first","affiliation":[{"name":"IBD Unit San Filippo Neri Hospital  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1839-8136","authenticated-orcid":false,"given":"Maria Lia","family":"Scribano","sequence":"additional","affiliation":[{"name":"Gastroenterology Unit San Camillo\u2010Forlanini Hospital  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Pugliese","sequence":"additional","affiliation":[{"name":"IBD Unit Digestive Disease Center (CEMAD) Fondazione Policlinico Universitario \"A. Gemelli\" IRCCS  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Baccolini","sequence":"additional","affiliation":[{"name":"Department of Public Health and Infectious Diseases Sapienza University of Rome  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabiola","family":"De\u00a0Biasio","sequence":"additional","affiliation":[{"name":"IBD Unit San Filippo Neri Hospital  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serena","family":"Verna","sequence":"additional","affiliation":[{"name":"Gastroenterology Unit San Camillo\u2010Forlanini Hospital  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Morretta","sequence":"additional","affiliation":[{"name":"IBD Unit Digestive Disease Center (CEMAD) Fondazione Policlinico Universitario \"A. Gemelli\" IRCCS  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4635-3050","authenticated-orcid":false,"given":"Stefano","family":"Festa","sequence":"additional","affiliation":[{"name":"IBD Unit San Filippo Neri Hospital  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Armuzzi","sequence":"additional","affiliation":[{"name":"IBD Unit IRCCS Humanitas Research Hospital, Rozzano  Milan Italy"},{"name":"Department of Biomedical Sciences Humanitas University, Pieve Emanuele  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio","family":"Papi","sequence":"additional","affiliation":[{"name":"IBD Unit San Filippo Neri Hospital  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,4,14]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra2002697"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.crohns.2013.01.010"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/ecco-jcc\/jjab029"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2036.2002.01140.x"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2013.07.041"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2020.10.039"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.284692"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/MIB.0b013e31829936c2"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2013.402"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.13847"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2013-305607"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2016.524"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.17145"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2017-315568"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1093\/ibd\/izz315"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1080\/00365521.2021.1897670"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2019-318440"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2017.01.035"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.14309\/ctg.0000000000000128"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1093\/ibd\/izad149"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)61908-5"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1093\/ecco-jcc\/jjy216"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1093\/ecco-jcc\/jjw169"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dld.2023.01.155"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/MOG.0000000000000638"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40265-020-01266-3"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1093\/ecco-jcc\/jjw168"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2009.301"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2014.09.031"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2020.03.064"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2007.03515.x"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dld.2008.09.010"},{"issue":"10","key":"e_1_2_9_34_1","first-page":"1317","article-title":"The revival of surgery in Crohn's disease\u2010early intestinal resection as a reasonable alternative in localized ileitis","volume":"9","author":"Kelm M","year":"2021","journal-title":"Biomedicine"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2018.12.022"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1093\/ecco-jcc\/jjad117"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000003395"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.11659"},{"key":"e_1_2_9_39_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2012.298"},{"key":"e_1_2_9_40_1","doi-asserted-by":"publisher","DOI":"10.1111\/codi.16021"},{"key":"e_1_2_9_41_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.26.2.146"},{"key":"e_1_2_9_42_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2011.448"},{"key":"e_1_2_9_43_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2014.297"},{"key":"e_1_2_9_44_1","doi-asserted-by":"publisher","DOI":"10.1093\/crocol\/otad003"},{"key":"e_1_2_9_45_1","article-title":"Early post\u2010operative endoscopy is associated with lower surgical recurrence of Crohn's disease: a retrospective study of three successive cohorts","author":"Amicone C","year":"2022","journal-title":"Gastroenterol Res Pract"},{"issue":"18","key":"e_1_2_9_46_1","first-page":"S1","article-title":"Extended mesenterectomy is not superior to mesenteric sparing resection in primary ileocolic resection for Crohn's disease in terms of postoperative endoscopic recurrence\u2014results of an international randomised controlled trial","author":"Van Der Does De Willebois E","year":"2024","journal-title":"J Crohns Colitis"},{"issue":"18","key":"e_1_2_9_47_1","first-page":"S1","article-title":"Postoperative endoscopic recurrence after resection of Crohn's terminal ileitis with Kono\u2010S or side\u2010to\u2010side functional end anastomosis: results of a multicenter prospective randomized trial","author":"Trencheva K","year":"2024","journal-title":"J Crohns Colitis"}],"container-title":["Alimentary Pharmacology &amp; Therapeutics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/apt.18001","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,2]],"date-time":"2025-06-02T16:10:53Z","timestamp":1748880653000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/apt.18001"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,14]]},"references-count":46,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2024,6]]}},"alternative-id":["10.1111\/apt.18001"],"URL":"https:\/\/doi.org\/10.1111\/apt.18001","archive":["Portico"],"relation":{},"ISSN":["0269-2813","1365-2036"],"issn-type":[{"value":"0269-2813","type":"print"},{"value":"1365-2036","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,14]]},"assertion":[{"value":"2023-11-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-04-02","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-04-14","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}