Long-term comparative outcomes after ileocecal resection for inflammatory versus complicated Crohn's disease. A multicenter, retrospective study (Crohn´s-Urg)

Background: Surgical intervention in Crohn's disease (CD) is often reserved for complications or failure of medical therapy. However, the benefits of early ileocecal resection for inflammatory phenotype (ICR) in patients with uncomplicated disease remain debated, particularly regarding long-term outcomes compared with complicated cases. Methods: This international, multicenter, retrospective cohort study evaluated long-term outcomes of ICR in patients with inflammatory (uncomplicated) and complicated CD phenotypes. Data from 2013 patients (291 with uncomplicated CD) who underwent surgery between 2012 and 2022 were analyzed. The primary endpoint was endoscopic disease recurrence, with secondary outcomes including clinical and surgical recurrence, fecal calprotectin levels, and risk factors for recurrence. Statistical analyses included Kaplan-Meier survival estimates, Cox regression, and multivariable modeling. Results: Complicated CD patients had higher rates of preoperative anemia, emergent surgery, and open procedures. Despite these differences, long-term endoscopic (HR: 1.03; p = 0.748), clinical (HR: 1.35; p = 0.073), and surgical recurrence rates (HR: 0.77; p = 0.419) were comparable between groups. Protective factors for recurrence included laparoscopic surgery (HR: 0.74; p = 0.009) and postoperative prophylaxis (HR: 0.63; p < 0.0001), while preoperative anemia (HR: 1.52; p < 0.0001) and positive margins (HR: 1.36; p = 0.001) increased recurrence risk. Conclusion: Long-term outcomes of ICR are similar in inflammatory and complicated CD when appropriate surgical and medical management is applied. Optimizing perioperative care and mitigating modifiable risk factors may improve outcomes, supporting the role of surgery even in less complicated CD cases.