Impact of advanced therapies on surgical recurrence following second ileocolic resection in Crohn's disease.

Aim: Long-term outcomes and potential benefits of evolved treatment strategies in patients with Crohn's disease (CD) undergoing a second ileocolic resection (second surgery) are not well characterized. This study aimed to evaluate the risk of a third surgery following second surgery in CD patients.

Method: This retrospective cohort study included CD patients undergoing second surgery between 2000-2021 in Amsterdam UMC. Primary outcome was a third surgery due to disease recurrence at the neoterminal ileum. Two cohorts were compared to assess changes over time: C1 (2000-2009) and C2 (2010-2021).

Results: In total, 110 patients were included (69 women [62.7%]; median age, 39 years [IQR 30-50]). The rates of third surgery were 12.1% at 5-years and 24.9% at 10-years. Use of prophylactic advanced therapies increased over time (C1: 16.4% vs C2: 41.7%, P = .004). However, the 5-year risk of third surgery was similar in both periods (C1: 12.5% vs C2: 11.5%, P = .45). Similarly, there was no statistically significant difference in third surgery risk between patients treated with vs without prophylactic advanced therapies (HR, 0.87 [95% CI, 0.37-2.02]). Most redo surgeries were performed for stricturing disease, even when the first surgery was for a different indication.

Conclusion: Following second surgery, the 5-year third surgery rate is 12.1%, which has remained stable over the past two decades. No statistically significant reduction in third surgery rates were observed in patients receiving prophylactic advanced therapies. This may reflect both the predominantly stricturing disease as indication for redo surgery, which is typically less amenable to medical treatment, and the shorter follow-up in C2.