UPmémoires

English

Background and aims

Early complicated Crohn’s disease (CD) may require ileal resection as first-line treatment. We aimed to evaluate the long-term outcomes of patients who underwent early ileal resection after diagnosis.

Methods

We conducted a retrospective study in two French inflammatory bowel diseases (IBD) referral centres, including patients with ileocecal resection and segmental ileal resection within 5 years following CD diagnosis. Early resection was defined as a surgery within 6 months following diagnosis, intermediate resection between 6 months and 2 years and late resection between 2 and 5 years. The primary outcome was the cumulative risk of a second ileal surgery. Secondary outcomes included the use of postoperative treatments and morphological recurrence after the initial surgery.

Results

Among the 393 patients who underwent ileal resection within the 5 years following CD diagnosis, 130 patients had an early resection, 128 had an intermediate resection and 135 had a late surgery. The cumulative risk of second surgery at 10-years, was not significantly different in the early resection group (25.0% [CI95% 17.4-35.2]), compared to intermediate (16,8% [CI95% 10.5-26.2]) (p=0.17) or late resection group (22.7% [CI95% 15.1-33.3]) (p=0.83). The early resection group required fewer postoperative treatments than the late resection group with median survivals without treatments of 3.7 years and 0.9 years, respectively (p=0.002). Early resected patients had significantly less evidence of morphological recurrence compared to the late resection group (p=0.02).

Conclusion

While early ileal resection in Crohn’s disease is not associated with a higher risk of second resection, it may be associated with reduced use of medical treatments and fewer morphological recurrences.