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 19 February 2018

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Early vs late surgery for ileo-cecal Crohn's disease

The latest issue of the Alimentary Pharmacology & Therapeutics investigates early versus late surgery for ileo-cecal Crohn's disease.

News image

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Surgical resection is almost inevitable in Crohn's disease.

Surgery is usually performed for refractory or complicated disease.

No studies appear to have been carried out, so far, to evaluate the potential benefits of performing surgery early in the course of the disease.

Clinical recurrence was lower in the early surgery group
Alimentary Pharmacology & Therapeutics

Dr Aratari and colleagues from Italy compared the long-term course of Crohn's disease.

Ileo-cecal resection was performed at the time of diagnosis (early surgery) or during the course of the disease (late surgery).

The team reviewed 207 patients with ileo-caecal Crohn's disease at their first resection .

The research team reported that 83 patients underwent early surgery, while 124 underwent late surgery, 54 months after diagnosis.

The team found the mean follow-up after surgery was 147 months.

The primary endpoint was clinical recurrence, defined as need for corticosteroids for symptomatic disease in the presence of endoscopic and/or radiologic recurrence.

Secondary endpoints were need for immunosuppressants and surgical recurrence.

The team used Kaplan-Meier survival method and Cox proportional hazards regression models.

The researchers found within 10 years after surgery, the cumulative probability of clinical recurrence was significantly lower in the early surgery group.

A trend was observed regarding the need for immunosuppressants.

No difference was observed regarding surgical recurrence.

The team found at multivariate analysis, that early surgery was the only independent variable associated with a reduced risk of clinical recurrence.

However, early surgery was not associated with the need for immunosuppressants and surgical recurrence.

Dr Aratari's team concluded, "Early surgery prolongs clinical remission compared to surgery performed during the course of the disease, but the natural history of disease is not modified."

Aliment Pharmacol Ther 2007: 26(10): 1303-12
12 November 2007

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