Abstract:

Objective To develop a nomogram for predicting the risks of early anastomotic recurrence （EAR） after primary bowel resection in patients with Crohn′s disease （CD）. Methods The patients with CD undergoing preoperative magnetic resonance enterography （MRE） and primary bowel resection were enrolled in this retrospective study and divided into an EAR group （18 patients） and EAR?free group （12 patients）. The EAR group included the patients having an endoscopic Rutgeerts score of ≥ I₂ month or the need for anastomotic resection within 12 months after surgery. All the 38 indexes including preoperative demographic characteristics， laboratory examinations， multi?parameter MRE features of the resected intestine and its adjacent mesentery， histological findings， and postoperative pharmacotherapy were analyzed. Least absolute shrinkage and selection operator （LASSO） regression and multivariate binary logistic regression analysis were performed to identify independent risk factors to be incorporated into the nomogram for predicting the risks of early anastomotic recurrence and the prediction performance was evaluated. Results Mesenteric creeping fat index on MRE and comb sign were independent risks of EAR， with a concordance index of 0.882 （95%CI： 0.764~1）. The calibration plot revealed a strong relationship between actual observation and predicted probability of EAR. Conclusions The preoperative MRE?based nomogram may be a potential tool for predicting EAR following surgery in patients with CD， which is beneficial to individual management in those patients. It provides reference for the formulation of early postoperative individualized drug adjuvant therapy in patients at high risk of EAR.

Key words: Crohn′s disease, magnetic resonance enterography, bowel resection, early anastomotic recurrence