Some patients with limited CD may benefit from an early surgical intervention

In a Danish cohort study, patients with limited Crohn’s disease (CD) who underwent early surgery had a lower cumulative risk of re-operation, consistent with a more benign postoperative disease course. Prospective studies are needed to define patient groups that will benefit most from a surgical intervention. 

In patients with CD with limited (affected segment ≤40 cm) and predominantly inflammatory terminal ileitis for whom conventional treatment is not successful, laparoscopic ileocaecal resection has shown to be a valid therapeutic alternative in the LIR!C trial [1]. In this trial, surgery led to a durable treatment effect comparable with infliximab treatment for these patients. However, there is limited data on early surgery among CD patients in general. To investigate the disease course in CD patients who underwent early versus late major abdominal surgery, a nationwide cohort study was performed using data from the Danish National Patient Registry and the Danish National Prescription Registry [2]. Dr Melek Zahra Sarikaya (Sjællands Universitetshospital, Denmark) and her team identified all CD patients diagnosed between 1 January 1997 and 31 December 2015 in Denmark. Included patients were stratified according to the time of surgery: Group 1 included 493 patients with an initial surgery within 29 days after diagnosis, group 2 had initial surgery between 30 and 180 days after diagnosis, and the ‘late surgery’ group 3 consisted of 1,518 patients that underwent surgery more than 180 days after their diagnosis. The 3 groups were compared regarding the need for re-operation, hospitalisation, and medications.

In group 1, participants had a lower cumulative re-operation risk but a higher hospitalisation risk. In addition, there was a significant decrease in time to re-operation for procedures performed after 2005. The re-operation risk was similar in group 2, but markedly elevated in group 3. The risk of hospitalisation was similar in groups 2 and 3, but lower than in group 1. The cumulative risk of immunomodulator use was highest in group 3 until 5 years. However, cumulative risk of biological use was not statistically significant between the groups. After 2005, the cumulative risk of hospitalisation decreased around 20% (P<0.05) and increased for immunomodulator and biological use by around 10% (P<0.05).

Early-resected CD patients showed advantages like a lower cumulative risk of re-operation, consistent with a more benign postoperative disease course. Moreover, their cumulative risk of immunomodulator use is lower in the initial years after surgery. According to the authors, closer monitoring and a faster decision regarding surgery among CD patients in general may lead to better long-term outcomes.

1. Stevens TW, et al. Lancet Gastroenterol Hepatol. 2020;5:900–7.
2. Sarikaya MZ, et al. Disease course and treatment outcomes of Crohn’s disease patients with early or late surgery: a Danish nationwide cohort study from 1997 to 2015. MP195, UEG Week 2022, 8–11 October, Vienna, Austria.

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Posted on 1 December, 2022