The association between intensified medical treatment, time to surgery and ileocolic specimen length in Crohn's disease

Abstract

Aim: During the last decade, treatment protocols have changed for patients with ileocolic Crohn's disease. Anti-tumour necrosis factor (anti-TNF) has become part of standard medical treatment, usually in a step-up approach. The aim was to analyse if improved medical treatment has resulted in more limited ileocolic resections and a longer interval between diagnosis and surgery. Method: Patients undergoing ileocolic resection for Crohn's disease were included (1999–2014). Patient characteristics were compared to the results of a population-based study (between 2004 and 2010) previously performed in the catchment area of the present tertiary referral centre. Time trends were analysed using the Cochrane–Armitage trend, Spearman's correlation coefficient and linear regression. Results: In total, 195 patients undergoing ileocolic resection were included. Patient characteristics were not significantly different from the background cohort, confirming a representative study group. Sixty-three patients were men (32.3%, median age at surgery 30.0 years, interquartile range 23.0–40.0). Anti-TNF and immunomodulator use prior to surgery increased significantly during the study period (χ2 = 49.1, P < 0.001). Over the years, a significant increase in time from diagnosis to operation was found (median 39.0 months, interquartile range 12.0–86.0, rho 0.175, P = 0.014). The length of the resected ileum did not change significantly (median 20.0 cm, interquartile range 12.0–30.0, rho −0.107, P = 0.143). The number of fistulas or postoperative complications that needed re-intervention was not significantly different between the groups with or without anti-TNF. Conclusion: This study demonstrated that over time patients with ileocolic Crohn's disease who eventually underwent ileocolic resection have been treated more intensively medically; however, this did not result in reduced specimen size.