Is early surgery an underestimated treatment in patients with limited CD?

Early surgery might benefit Crohn's patients, but identifying exact patient groups who will benefit from early surgery requires prospective studies.

Limited data on early surgery among CD patients

Laparoscopic ileocaecal resection has shown to be a valid therapeutic alternative in patients with CD who fail to respond to biologics in the LIR!C trial1. In this trial, surgery led to a durable treatment effect comparable with patients treated with infliximab in CD patients with limited and predominantly inflammatory terminal ileitis.

However, there is limited data on early surgery among CD patients.  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 Registry2.

Cumulative risk of biologicals was not statistically significant

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 from diagnosis, and the late surgery group 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, patients 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 immune-modulator use was highest in group 3 until 5 years.

However, cumulative risk of biologicals was not statistically significant between the groups. After 2005, the cumulative risk of hospitalisation decreased around 20% (P<0.05) and increased for immunomodulators and biologicals by around 10% (p <0.05).

That early-resected CD patients showed advantages like a lower cumulative risk of re-operation, consistent with a more benign postoperative disease course among early-resected CD patients.  Moreover, their cumulative risk of immune-modulator use is lower in the initial years after surgery. According to the authors, closer monitoring and a quicker decision upon 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, Vienna, Austria, 8-11 October.