Editorial: Beyond Resection—Rethinking Postoperative Management in Colonic Crohn's Disease. Authors' Reply

We thank Drs. Aratari and Festa for their thoughtful editorial 1 accompanying the RESECOL study 2. Their commentary raises important points that we believe deserve further elaboration and, in our view, largely reinforce the conclusions of our work. Regarding the definition of endoscopic recurrence, we fully agree that the absence of validated scoring systems for colocolonic and ileorectal anastomoses represents a relevant limitation (indeed one we explicitly acknowledged). The inapplicability of the Rutgeerts score in this setting is precisely why RESECOL defined endoscopic recurrence as the presence of anastomotic or perianastomotic CD-associated lesions at the first postoperative endoscopy. While imperfect, this pragmatic definition allowed for a systematic description of endoscopic outcomes after colectomy in colonic CD, and we hope it may serve as a starting point for future consensus-based definitions in this underexplored area. We acknowledge the heterogeneity in postoperative assessment timing, which is inherent to the retrospective, multicentre design of the study. To address this, we performed sensitivity analyses restricted to evaluations within 12 and 24 months after surgery. Although sample sizes were reduced-particularly in the subtotal colectomy group-the direction and magnitude of results remained consistent with the primary analysis. We agree with the editorialists that prospective studies with standardised surveillance protocols are needed, and we consider this one of the main research priorities emerging from our data. The absence of data on the number of affected colonic segments, stoma risk and surgical complications is an important limitation we recognise. These variables are undeniably relevant for surgical planning, and their inclusion in future prospective registries should be prioritised. Nevertheless, the primary aim of RESECOL was to describe postoperative recurrence outcomes and their predictors. The inverse probability of treatment weighting analysis, based on a comprehensive set of baseline covariates, was specifically designed to mitigate confounding by indication, and its results were consistent with those of the primary analysis. With respect to faecal calprotectin, we agree that its systematic evaluation in all patients would have strengthened the findings. Nonetheless, RESECOL is, to our knowledge, the first study to report faecal calprotectin cutoff values for postoperative monitoring in colonic CD, a finding we consider clinically relevant and worthy of prospective validation. Finally, we note that the meta-analyses cited by the editorialists primarily addressed surgical recurrence, whereas RESECOL extends the evidence to clinical and endoscopic outcomes. We are grateful to Drs. Aratari and Festa for contextualising our findings within the landscape of colonic CD management and for highlighting the need for prospective data. We share their view that a multidisciplinary, patient-centred approach, incorporating recurrence risk stratification, structured post-operative monitoring and optimised prophylactic therapy is essential to improve long-term outcomes in this setting. We also believe that, given the lower frequency of colonic CD surgery, collaborative efforts led by societies (such as GETECCU 3) are essential for a better characterisation of post-operative outcomes of this phenotype. José Luis Rueda García: conceptualization, writing – original draft. Cristina Suárez-Ferrer: writing – review and editing. Yamile Zabana: writing – review and editing, supervision. The authors have nothing to report. The authors' declarations of personal and financial interests are unchanged from those in the original article 2. This article is linked to Rueda García et al. papers. To view these articles, visit https://doi.org/10.1111/apt.70608 and https://doi.org/10.1111/apt.70680. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.