P200 - Risk Factors for Small Bowel Crohn’s Disease Recurrence after Total Proctocolectomy

Saturday, May 9, 2026

2:28 PM - 2:36 PM ET

Abstract Podium Presenter(s)

Maxwell D. Mirande, DO (he/him/his)

Colon and Rectal Surgery Fellow
Mayo Clinic
Mayo Clinic Rochester
Rochester, MN, United States

All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose

Author(s)

Ana Sofia Ore, MD MSc MPH (she/her/hers)

Colon & Rectal Surgery Fellow
Mayo Clinic Rochester
Mayo Clinic - Rochester
Rochester, MN, United States

All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose
EF

Emily Flaherty, MD

Resident
Mayo Clinic
Rochester, Minnesota, United States

Disclosure information not submitted.
Ian S. Reynolds, MB BCh BAO MCh PhD FRCSI

Fellow - Colon and Rectal Surgery
Mayo Clinic, Rochester, Minnesota
Rochester, MN, United States

Disclosure information not submitted.
AA

Ahmed Amine Alaoui, MD MPH

Colon and Rectal Surgery Fellow
Mayo Clinic
Mayo Clinic
Rochester, MN, United States

Disclosure information not submitted.
Danilo Tueme de la Pena, MD (he/him/his)

Colon and Rectal Surgery Fellow
Mayo Clinic
Mayo Clinic
Rochester, MN, United States

Disclosure information not submitted.
Matas Jakubauskas, MD, PhD (he/him/his)

Colorectal surgery fellow
Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota
Mayo Clinic, Rochester, Minnesota
Rochester, MN, United States

All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose
NM

Nitin Mishra, MBBS, MS, MPH

Consultant
Mayo Clinic Arizona
Phoenix, Arizona, United States

Disclosure information not submitted.
LS

Luca Stocchi, MD,MBA

chair division of colorectal surgery
mayo clinic
Mayo Clinic Florida
Jacksonville, FL, United States

All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose
William R. Perry, MBChB MPH FRACS FACS FASCRS (he/him/his)

Associate Professor of Surgery
Mayo Clinic
Mayo Clinic
Rochester, Minnesota, United States

All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose
Kellie L. Mathis, M.D. (she/her/hers)

Professor of Surgery
Mayo Clinic
Mayo Clinic
Oronoco, Minnesota, United States

Disclosure information not submitted.

Senior Author(s)

NM

Nicholas P. McKenna, M.D.

Assistant Professor of Surgery
Mayo Clinic
Rochester, Minnesota, United States

Disclosure information not submitted.

Purpose/Background: Medically refractory Crohn's disease (CD) of the colon and rectum is managed with total proctocolectomy with end ileostomy (TPC+EI). However, there is limited data on the need for CD-directed therapy and CD recurrence after TPC+EI. Therefore, we aimed to determine the risk of small bowel CD recurrence and evaluate risk factors for postoperative CD recurrence.

Methods/Interventions: A retrospective review was conducted on all adult patients with CD who underwent a TPC+EI between January 2014 and December 2023 across three sites of a multistate health system. Patients who underwent prior ileocecectomy or single segmental colonic resection before TPC+EI were included. Patient demographics, CD characteristics, and long-term CD outcomes were collected. The primary outcome was small bowel CD recurrence, defined as the first postoperative detection of active CD diagnosed by either imaging, endoscopy, or need for further CD surgery (small bowel resection and/or stricturoplasty). Small bowel CD recurrence-free survival was calculated from the time of TPC+EI to the date of first recurrence, censoring at the date of last follow-up. Kaplan-Meier survival analysis compared small bowel CD recurrence-free survival across different patient characteristics, and multivariable Cox-proportional hazard analysis was used to determine independent risk factors for small bowel CD recurrence.

Results/Outcomes: A total of 193 patients (54% female) with a median age of 45 years (interquartile range [IQR], 34-61) underwent TPC+EI. The median age of CD diagnosis was 28 years (IQR, 20-45). Medically refractory disease was the most common indication for surgery (n=152, 78.8%) followed by dysplasia/cancer (n=42, 21.2%). Over half of the patients (n=102, 52.9%) had a history of small bowel CD and 18.1% (n=35) of patients underwent prior small bowel surgery for CD. The majority of patients received biologic therapy within 3 months of surgery (n=134, 69.4%).

The median follow-up time was 4.8 years (IQR, 2.0-7.6). Postoperatively, 30.6% of patients (n=59) had received biologic therapy. A total of 35 patients (18.1%) had small bowel CD recurrence for an estimated 5-year recurrence-free rate of 80.2% (95% confidence interval [CI], 73.0-85.7). Only seven patients (3.6%) developed small bowel CD recurrence requiring surgery for an estimated 5-year surgical recurrence-free rate of 94.7% (95% CI, 89.0-97.5). On multivariable analysis, history of small bowel CD (hazard ratio [HR] 2.17; 95% CI‚ 1.04-4.54) and CD diagnosis at age < 18 years (HR 2.31; 95% CI‚1.1-4.86) were associated with small bowel CD recurrence (Figure 1).

Conclusion/Discussion: Patients undergoing TPC+EI for CD have an approximate 20% risk of small bowel CD recurrence at 5 years but a low risk of requiring surgical intervention. Patients with a history of small bowel CD and younger age at CD diagnosis (age < 18) have a higher risk of recurrence and may benefit from more frequent surveillance and more aggressive prophylactic medical management.

Figure 1. Crohn's disease recurrence-free survival stratified by A) history of small bowel Crohn's disease and B) by age at diagnosis of Crohn's disease.