Early versus late surgery in patients with intestinal behçet disease

BACKGROUND: To date, no studies have been conducted to evaluate the potential benefits of early surgery in patients with intestinal Behçet disease. OBJECTIVE: We investigated the long-term clinical outcomes in patients with intestinal Behçet disease first diagnosed at surgery ("early surgery") compared with those requiring surgical resection during the course of the disease ("late surgery"). DESIGN: This is a retrospective cohort study. SETTINGS: This study was conducted at a single tertiary academic medical center. PATIENTS: We reviewed the medical records of 272 consecutive patients with intestinal Behçet disease between March 1986 and August 2010. MAIN OUTCOME MEASURES: The cumulative probabilities of clinical recurrence and reoperation after operation were the main outcomes measures. RESULTS: Forty of 272 patients were first diagnosed with intestinal Behçet disease at surgery (early surgery); the remaining 232 were diagnosed clinically, with 62 undergoing surgery during their follow-up after clinical diagnosis (late surgery). The cumulative probabilities of postoperative clinical recurrence and reoperation were significantly lower in the early-surgery group than in the late-surgery group (p = 0.045 and p = 0.003). In multivariate analysis, early surgery was the only independent factor significantly associated with a reduced probability of reoperation (HR 0.26; 95% CI 0.10-0.71; p = 0.008). However, when we analyzed only the patients who underwent surgery because of chronic symptoms, early surgery was not associated with lower cumulative clinical recurrence and reoperation rates (p = 0.896 and p = 0.492). LIMITATIONS: We analyzed the clinical characteristics retrospectively, and the number of patients was insufficient to reach a decisive conclusion. CONCLUSIONS: According to the current study, the patients with intestinal Behçet disease undergoing early surgery showed better prognoses in comparison with those undergoing late surgery. Early surgery may represent a valid approach in the initial management of the patients with intestinal Behçet disease, at least in the subset of the patients with acute symptoms.