Early versus late surgery for ileo-caecal Crohn's disease

A. Aratari, C. Papi, G. Leandro, A. Viscido, L. Capurso, R. Caprilli

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Abstract

Background: 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. Aim: To compare the long-term course of Crohn's disease following ileo-caecal resection performed at the time of diagnosis (early surgery) or during the course of the disease (late surgery). Patients and methods: Overall 207 patients with ileo-caecal Crohn's disease at their first resection were reviewed: 83 patients underwent surgery at the time of diagnosis (early surgery), while 124 underwent surgery 54.2 months (range 1-438) after diagnosis (late surgery). The mean follow-up after surgery was 147 months (range 12-534). 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. Statistical analysis: Kaplan-Meier survival method and Cox proportional hazards regression model. Results: Within 10 years after surgery, the cumulative probability of clinical recurrence was significantly lower in the early surgery group (Log Rank test P = 0.01). A trend was observed regarding the need for immunosuppressants (P = 0.05). No difference was observed regarding surgical recurrence. At multivariate analysis, early surgery was the only independent variable associated with a reduced risk of clinical recurrence (Hazard ratio, HR = 0.57; 95% CI 0.35 to 0.92, P = 0.02), but not with need for immunosuppressants and surgical recurrence (HR = 0.51; 95% CI 0.20 to 1.30, P = 0.15; HR = 0.66; 95% CI 0.33 to 1.35, P = 0.25, respectively). Conclusion: Early surgery prolongs clinical remission compared to surgery performed during the course of the disease, but the natural history of disease is not modified.

Original languageEnglish
Pages (from-to)1303-1312
Number of pages10
JournalAlimentary Pharmacology and Therapeutics
Volume26
Issue number10
DOIs
Publication statusPublished - Nov 2007

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Cecal Diseases
Crohn Disease
Recurrence
Immunosuppressive Agents

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Pharmacology, Toxicology and Pharmaceutics(all)

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Early versus late surgery for ileo-caecal Crohn's disease. / Aratari, A.; Papi, C.; Leandro, G.; Viscido, A.; Capurso, L.; Caprilli, R.

In: Alimentary Pharmacology and Therapeutics, Vol. 26, No. 10, 11.2007, p. 1303-1312.

Research output: Contribution to journalArticle

Aratari, A. ; Papi, C. ; Leandro, G. ; Viscido, A. ; Capurso, L. ; Caprilli, R. / Early versus late surgery for ileo-caecal Crohn's disease. In: Alimentary Pharmacology and Therapeutics. 2007 ; Vol. 26, No. 10. pp. 1303-1312.
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abstract = "Background: 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. Aim: To compare the long-term course of Crohn's disease following ileo-caecal resection performed at the time of diagnosis (early surgery) or during the course of the disease (late surgery). Patients and methods: Overall 207 patients with ileo-caecal Crohn's disease at their first resection were reviewed: 83 patients underwent surgery at the time of diagnosis (early surgery), while 124 underwent surgery 54.2 months (range 1-438) after diagnosis (late surgery). The mean follow-up after surgery was 147 months (range 12-534). 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. Statistical analysis: Kaplan-Meier survival method and Cox proportional hazards regression model. Results: Within 10 years after surgery, the cumulative probability of clinical recurrence was significantly lower in the early surgery group (Log Rank test P = 0.01). A trend was observed regarding the need for immunosuppressants (P = 0.05). No difference was observed regarding surgical recurrence. At multivariate analysis, early surgery was the only independent variable associated with a reduced risk of clinical recurrence (Hazard ratio, HR = 0.57; 95{\%} CI 0.35 to 0.92, P = 0.02), but not with need for immunosuppressants and surgical recurrence (HR = 0.51; 95{\%} CI 0.20 to 1.30, P = 0.15; HR = 0.66; 95{\%} CI 0.33 to 1.35, P = 0.25, respectively). Conclusion: Early surgery prolongs clinical remission compared to surgery performed during the course of the disease, but the natural history of disease is not modified.",
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