EARLY ILEOCECAL RESECTION IN CROHN'S DISEASE: A SYSTEMATIC REVIEW.

BACKGROUND

The approval of new therapies has led to an increasing trend toward the use of various combinations of medications in Crohn's disease (CD) management. However, patients with ileocecal CD may still require surgery in up to 80% of cases.

OBJECTIVES

To analyze the literature and synthesize the data qualitatively to evaluate the outcomes of early surgery compared to drug therapy in patients with ileocecal CD, focusing on both adult and pediatric populations.

METHODS

Studies were selected through an electronic search of the PUBMED database, following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The MINORS (Methodological Index for Non-Randomized Studies) criteria were used to assess the methodological quality of non-randomized studies.

RESULTS

A total of 665 articles were initially identified through the search strategy, and three additional relevant articles were added manually, leading to 22 studies eligible for qualitative evaluation. The evaluation of results was organized based on primary outcomes. Three studies assessed postoperative morbidity, with two showing higher morbidity in patients who underwent surgery for CD complications compared to those operated on for a purely inflammatory phenotype. Twelve observational studies evaluated CD recurrence, with ten showing evidence of higher surgical recurrence in patients who underwent surgery at a later stage. These studies demonstrated worse long-term clinical control of CD in this group, with a higher need for corticosteroids and advanced therapies. Only two pediatric studies met the inclusion criteria, limiting a more comprehensive analysis of this population.

CONCLUSION

Early surgery in adult patients is a solid therapeutic option in the treatment of uncomplicated isolated ileocecal CD.