A contemporary, evidence-based approach to the management of Crohn’s disease (CD) after surgical resection involves risk stratification, strategic postoperative monitoring, shared-decision making and timely initiation of prophylactic therapy in select individuals. Advances in biomarker development, imaging and therapeutic options enriched the armamentarium available to mitigate postoperative recurrence (POR) and hopefully improve long-term outcomes. This narrative review article collates the latest evidence and expert guidance to offer practical recommendations on monitoring and managing CD after surgery. Identifying patients at elevated risk for recurrence is crucial to guiding postoperative management decisions. Active smoking remains the most consistently validated risk factor for POR. Genetic and microbiome-related factors may herald a future role for precision medicine in risk stratification. Major guidelines still recommend risk stratification to identify high-risk patients in whom early medical prophylaxis should be considered, most commonly with anti-tumour necrosis factor agents as a recommended first-line therapy. Advanced therapies are emerging as efficacious options as well, both to prevent and treat POR. The need for surgery in the management of CD remains and POR of CD following resection is common, even in the era of newer biological agents. Risk stratification may help guide postoperative care between medical prophylaxis and close disease activity monitoring, although current data is leaning in favour of early medical prophylaxis with advanced therapies due to lower risk of POR. Ongoing trials will help elucidate the optimal approach. Assessments of precision medicine approaches are underway and will hopefully signal the next era of postoperative CD care.
Greenwood et al. (Wed,) studied this question.