The Revival of Surgery in Crohn’s Disease—Early Intestinal Resection as a Reasonable Alternative in Localized Ileitis

Abstract

Crohn’s disease (CD) represents a heterogeneous and complex disease with no curative therapeutic option available to date. Current therapy is mainly antibody-based focusing on the immune system while other treatment alternatives such as surgery are considered to be “last options”. However, medical therapy for CD results in mild to severe side effects in a relevant amount of patients and some patients do not respond to the medication. Following that, quality of life is often significantly reduced in this patient cohort, thus, therapeutic alternatives are urgently needed. Updated evidence has revealed that surgery such as ileocecal resection (ICR) might be a potential therapeutic option in case of localized terminal ileitis since resection at early time points improves quality of life and significantly reduces the postoperative need for immunosuppressive medication with low rates of morbidity. In addition, new surgical approaches such as Kono-S anastomosis or inclusion of the mesentery result in significantly reduced rates of disease recurrence and reoperation. Based on the new evidence, the goal of this review is to provide an update on the role of surgery as a reasonable alternative to medical therapy in the interdisciplinary treatment of patients with CD.

Crohn's disease after surgery: Changes in post‐operative management strategies over time and their impact on long‐term re‐operation rate—A retrospective multicentre real‐world study

“…These data suggest no substantial impact of early introduction of IMMs and anti‐TNFα agents after surgery on the risk of long‐term re‐operation and are in line with other studies in which high rates of clinical and surgical recurrence are reported despite the impact of preventive therapy on endoscopic lesions and the endoscopy‐guided therapy modifications 30 . Furthermore, as previously reported, early surgery was not associated with a greater risk of re‐operation, 31–33 and, even considering that the changes in surgical techniques are the historical prerogative of only the III cohort, a lower risk of surgical recurrence was not observed in the last cohort compared with the historical cohorts.…”

Surgical Strategies to Reduce Postoperative Recurrence of Crohn's Disease After Ileocolic Resection

“…This trial is randomising patients to one of four groups; It will be a significant breakthrough in the management of CD if the Kono-S anastomosis or extended mesenteric resection are definitely proven to be effective at reducing POR after ileocolic resection, particularly given the lack of certainty regarding the efficacy of medications at reducing POR. The evolution of new techniques are coming at an important time when we are likely to see more patients with isolated ileocolic disease being referred for consideration for surgical resection (106)(107)(108)(109). The reason for this is based on a number of publications including the LIR!C trial which has demonstrated that laparoscopic ileocaecal resection is cost effective and results in similar quality of life as induction and maintenance treatment with infliximab in patients with non-stricturing limited (affected segment ≤40 cm) ileocaecal CD for whom conventional treatment was unsuccessful (110,111).…”

Long‐term outcomes following ileocolic resection for Crohn's disease: does earlier elective resection affect disease recurrence rates?

“…3 The treatment of CD, and along with it the role of surgery, has evolved throughout history: from surgery as the treatment of choice in the early 30s of the previous century and up to the current era dominated by modern pharmacological therapies, thus decreasing surgical intervention rates. 4 Nonetheless, surgery remains the only alternative in treating disease complications or refractory disease. 5 Despite optimal therapy, up to 70% of patients will require surgical intervention at 10 years from diagnosis secondary to medical treatment failure.…”