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INTRODUCTION: While ileocolic resection is the most common surgical procedure for Crohn's disease (CD), many physicians prefer to initiate pharmacotherapy before considering surgery. This study aimed to compare early ileocolic resection (EICR) with medical treatment (MT) for localized ileocolic CD. METHODS: A systematic search was conducted across PubMed, Cochrane, Embase, and Google Scholar. Inclusion criteria required studies to compare EICR (performed within 18 months of initial diagnosis) without the use of biologics to MT, with primary outcomes being the need for CD-related surgery and the use of biologics. RESULTS: Five studies involving 1770 patients, both pediatric and adult, were included in this analysis. The data showed that in the EICR cohort, which comprised 740 patients, the rate of CD-related surgery within 5 years of initial treatment was 2.43%. In contrast, the MT cohort, consisting of 1030 patients, had a much higher surgery rate of 20.58% (P < 0.001). Additionally, at a mean follow-up of 5 years, the long-term use of biologics was significantly lower in the EICR cohort compared to the MT cohort, with rates of 18.38% and 72.91% respectively (P < 0.001). CONCLUSION: An EICR operation for localized ileocolic CD was associated with longer and more stable remission, resulting in improved long-term outcomes compared to medical therapy alone. In cases of localized ileocolic CD where MT fails to improve disease activity after several months, early surgical intervention may provide a safe and effective way to achieve disease remission and enhance the overall quality of life for patients.
Hyon et al. (Wed,) studied this question.