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October 5, 2025Open Access

Association of appendectomy with disease phenotype and clinical course in Crohn's disease: results from two cohorts

YCYaning ChenNational Institutes of Health YCYanli ChengBinzhou University TSTongxing SongHuazhong Agricultural University

Key Points

Appendectomy is linked to lower prevalence of perianal lesions in Crohn's disease patients, indicating a potential protective effect.
Patients who had an appendectomy exhibited later disease onset and diagnosis compared to those without the procedure.
Significant differences in clinical presentation were noted across Montreal classification parameters in surgical cohorts.
Despite its phenotype differences, appendectomy did not notably influence the overall clinical course of Crohn's disease.

Abstract

The appendix, as a component of the digestive system, plays a role in intestinal immunity. To investigate the association between appendectomy history and disease phenotype/progression in Crohn's disease patients. Two cohorts from a single center. Patients with Crohn's disease diagnosed between 2011 and 2021, including those without surgery and those undergoing their first surgery for Crohn's disease. Patients were divided into surgical and non-surgical cohorts, each further split into appendectomy and non-appendectomy groups. In the non-surgical cohort, significant phenotypic disparities were observed between appendectomy-only and non-appendectomy groups across Montreal classification parameters, including age (p < 0.001), location (p = 0.03), and behavior (p = 0.01), with reduced perianal lesion prevalence in appendectomy patients (15% (9/60) vs. 35.7% (162/454), p = 0.001). Appendectomy patients exhibited later disease onset (IQR36 vs. 24 years, p < 0.001) and diagnosis (IQR37 vs. 26 years, p < 0.001). In the surgical cohort, significant differences emerged among non-appendectomy, appendectomy-only, and ileocecal resection groups in Montreal classification parameters: age at diagnosis (p = 0.014), location (p < 0.001), and behavior (p = 0.003). Disease progression timelines differed markedly, with later onset (IQR 29 vs. 27 vs. 25 years, p < 0.001), diagnosis (IQR 31 vs. 30 vs. 27 years, p < 0.001), and surgery (IQR 35 vs. 33 vs. 31 years, p < 0.001) observed in appendectomy-only patients. Surgical management varied significantly, including diagnosis-to-surgery intervals (mean 3.4 vs. 2.6 vs. 3.7 years, p < 0.001), perianal lesion (29.3% (123/420) vs. 24.4% (39/160) vs. 35.3% (173/490), p = 0.02), and one-stage surgery (36.2% (152/420) vs. 75.6% (120/160) vs. 66.1% (324/490), p < 0.001). Retrospective analysis with potential data biases. Despite notable differences in disease phenotype, appendectomy does not seem to influence the clinical course of Crohn's disease. However, it seems to be associated with the lower risk of perianal disease and alleviates the severity of their condition.

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