Too late to operate? Early surgical assessment in the era of advanced medical therapy for Crohn's disease.

BACKGROUND: The expanding availability of advanced medical therapies has profoundly reshaped the management of Crohn's disease. However, an unintended consequence may be the progressive deferral of surgical involvement, with patients often referred only after exposure to multiple treatment lines and with more advanced, high-risk disease. OBJECTIVE: To argue that the key paradigm shift should not be 'early surgery' per se, but rather early surgical assessment as a standard component of multidisciplinary care. METHODS: In this opinion letter, we discuss the implications of delayed surgical involvement and the potential role of integrating surgical assessment earlier in the disease course. RESULTS: Timely surgical involvement may allow better patient selection, improved preoperative optimisation and more appropriate treatment sequencing.