• Crohn's disease
• ileo-colic resection
• post-operative recurrence
• sarcopenia

Sarcopenia is defined as reduction in skeletal muscle mass and muscle strength; it was found in up to 50% of patients with Crohn's disease (CD) in several studies. In CD patients sarcopenia is a risk factor for surgery, post-operative complications and worse surgical outcomes; furthermore, it is a negative prognostic factor for endoscopic remission in patients treated with biologics. The aim of our study was to evaluate the impact of sarcopenia on endoscopic recurrence at 6-12 months follow-up in CD patients after ileo-colic resection.
CD patients undergoing primary elective ileo-colic resection surgery between 2013 and 2023 were enrolled. Patients with previous intestinal surgery, pre-operative complications (abscess, perforation) and immunosuppressive or biologic therapy after surgery were excluded.
Sarcopenia was defined as the sex- and height-adjusted Total Psoas Area Index (TPAI) lower than 5.4 cm2/m2 (men) and 3.56 cm2/m2 (women), calculated at the level of the third lumbar vertebra on MRI scans performed within 3 months before surgery. Already known risk factors for post-surgical disease recurrence were considered (length and extent of disease +/- peri-anal disease, smoking, family history of IBD, comorbidities, biological/immunosuppressive therapy in the 3 months prior to surgery, extent of resection and residual active disease). All follow-up endoscopic exams were performed by expert operators frome the IBD group in dedicated sessions. Uni- and multi-variate analyses were performed to evaluate if sarcopenia before surgery could influence endoscopic recurrence (Rutgeers score ≥ i2) of disease 6-12 months after surgery.
Seventy-two CD patients were included. Endoscopic recurrence (at 6-12 months follow-up colonscopy) was found in 22% of patients and it was associated with the presence of pre-operative sarcopenia (1.4% vs 15.3%;p<0.001) and short-term (< 30 days) surgical complications [(according to Clavien Dindo >/= 3, (2.78% vs 6.94%;p=0.024)], while it was not associated with comorbidies, familiarity, smoke, extension of resection or pre-operative therapy, PCR and albumin. Sarcopenia was identify as predictor of endoscopic recurrence (OR=25;p=0.005) as well as surgical complications after resection (OR=9.97;p=0.032). Neither medical or surgical complications showed statistically significant correlation with the presence of pre-operative sarcopenia (p=0.819). Sarcopenia in CD patients before surgery seems to be an independent prognostic factor for endoscopic recurrence. The determination of TPAI calculated on enteroRM scans is a simple and cost-effective method that correlates well with sarcopenia as data from the literature show. Peri-operative interventions to improve sarcopenia may have positive impact on surgical outcomes and disease recurrence and there is the need to establish shared treatment protocols.