The Role Of Upfront Surgery in the Management of Ileal Crohn’s Disease

Authors

  • Paulo Gustavo Kotze, MD Health Sciences Postgraduate Program, Catholic University of Paraná (PUCPR), Curitiba, Brazil

DOI:

https://doi.org/10.58931/cibdt.2024.2228

Abstract

Crohn's disease (CD) is a chronic inflammatory disorder characterized by transmural inflammation that can affect any part of the gastrointestinal tract. Among the various phenotypes of CD, involvement of the terminal ileum, known as ileal CD, poses unique challenges in management due to its potential for complications such as strictures, fistulas, and abscesses. While medical therapy remains a cornerstone in the management of CD, the role of surgery, particularly upfront surgical intervention (early resection), has garnered increasing attention in recent years. 

The decision to pursue surgical intervention at the outset of disease management, rather than relying solely on medical therapy, is a subject of ongoing debate in the field. Upfront surgery (prior to advanced medical therapies) may offer benefits such as rapid resolution of symptoms, avoidance of long-term immunosuppressive therapy and prevention of disease progression. However, concerns regarding the postoperative morbidity and potential for recurrence associated with surgical intervention warrant careful consideration.

Author Biography

Paulo Gustavo Kotze, MD, Health Sciences Postgraduate Program, Catholic University of Paraná (PUCPR), Curitiba, Brazil

Paulo Gustavo Kotze is Adjunct Senior Professor of Surgery of the Colorectal Surgery Unit at Cajuru University Hospital of the Catholic University in Curitiba, Paraná, Brazil. He received his medical degree at the Federal University of Paraná in 1997 and completed his General Surgery training at the Evangelical University Hospital in Curitiba (2000). He also completed his senior Fellowship in Colorectal Surgery at the Clinics Hospital from the Federal University of Parana (2002). Dr. Kotze achieved his Masters' Degree on Surgery at the Catholic University in 2008 and joined the faculty of medicine at the same university in 2011, as assistant professor of surgery. He achieved his PhD degree studying the influence of biological therapy on surgical outcomes in Crohn´s disease, in the University of Campinas, in São Paulo, Brazil (UNICAMP) in 2015. Dr. Kotze was also an IBD advanced visiting fellow in the IBD unit at the University of Calgary (Cumming school of medicine), Canada, for the period of 2017- 2018. Currently, he is Professor of the Postgraduate Health Sciences Program at the Catholic University of Paraná. Dr. Kotze is an experienced academic IBD surgeon and author of 3 books, more than 200 PubMed peer-reviewed articles and multiple book chapters focused on Crohn´s disease and ulcerative colitis. He has special interest in the fields of surgery, biological therapy and epidemiology in IBD. He actively participates on the directory board of the Brazilian Study group for IBD (GEDIIB) and is currently co-editor of the Journal of Coloproctology (periodical of the Brazilian society of colorectal surgeons) and participates as an international editorial board member of the Lancet Gastroenterology and Hepatology, Journal of Crohn’s and Colitis, Colorectal Disease, Intestinal Research, Therapeutic Advances in Gastroenterology, Techniques in Coloproctology and the British Journal of Surgery. He is also a reviewer for several international journals such as Gut, Alimentary Pharmacology and Therapeutics, Clinical Gastroenterology and Hepatology, Gastroenterology, among others. Dr. Kotze was formerly a committee member of S-ECCO (surgeons of ECCO) from 2015-2018 and a member of the ECCO EduCOM (educational committee), from 2018-2022. In 2020, he was selected as a full active member of IOIBD (International Organization for the Study of Inflammatory Bowel Disease). He is also a senior researcher of the Brazilian National Research Council (CNPq). 

References

Roda G, Chien Ng S, et al. Crohn’s disease. Nat Rev Dis Prim. 2020 Dec 1;6(1). DOI: https://doi.org/10.1038/s41572-020-0156-2

Yamamoto T, Lightner AL, Spinelli A, et al. Perioperative management of ileocecal Crohn’s disease in the current era. Expert Rev Gastroenterol Hepatol. 2020 Sep 1 [cited 2024 May 27];14(9):843-55. DOI: https://doi.org/10.1080/17474124.2020.1802245

Avellaneda N, Kotze PG. Author’s reply: “Early surgery for Crohn’s disease-An appeal for a reassessment of biologics.” Dig Liver Dis. 2023 Dec 1;55(12):1777-8. DOI: https://doi.org/10.1016/j.dld.2023.09.005

Agrawal M, Ebert AC, Poulsen G, et al. Early ileocecal resection for Crohn's disease is associated with improved long-term outcomes compared with anti-tumor necrosis factor therapy: a population-based cohort study.. Gastroenterol. 2023 Oct 1;165(4):976-985.e3. DOI: https://doi.org/10.1053/j.gastro.2023.05.051

Ponsioen CY, de Groof EJ, Eshuis EJ, A, et al. Laparoscopic ileocaecal resection versus infliximab for terminal ileitis in Crohn’s disease: a randomised controlled, open-label, multicentre trial. Lancet Gastroenterol Hepatol. 2017 Nov 1;2(11):785-92.

Stevens TW, Haasnoot ML, D’Haens GR, et al. Laparoscopic ileocaecal resection versus infliximab for terminal ileitis in Crohn’s disease: retrospective long-term follow-up of the LIR!C trial. Lancet Gastroenterol Hepatol. 2020 Oct 1;5(10):900-7.

Vieujean S, Kotze PG, Netter P, et al. Stemming the tide with ileocecal Crohn’s disease: when is pharmacotherapy enough? Expert Opin Pharmacother. 2023;24(14):1595-607. DOI: https://doi.org/10.1080/14656566.2023.2232726

Colombel JF, Panaccione R, Bossuyt P, et al. Effect of tight control management on Crohn’s disease (CALM): a multicentre, randomised, controlled phase 3 trial. Lancet. 2017 Dec 23;390(10114):2779-89. DOI: https://doi.org/10.1016/S0140-6736(17)32641-7

Kotze PG, Magro DO, Martinez CAR, et al. Long Time from Diagnosis to Surgery May Increase Postoperative Complication Rates in Elective CD Intestinal Resections: An Observational Study. Gastroenterol Res Pract. 2018 Apr 23;2018:4703281. DOI: https://doi.org/10.1155/2018/4703281

Avellaneda N, Coy CSR, Fillmann HS, et al. Earlier surgery is associated to reduced postoperative morbidity in ileocaecal Crohn’s disease: Results from SURGICROHN - LATAM study. Dig Liver Dis. 2023 May 1;55(5):589-94. DOI: https://doi.org/10.1016/j.dld.2022.09.011

Maruyama BY, Ma C, Panaccione R, Kotze PG. Early Laparoscopic ileal resection for localized ileocecal Crohn's disease: hard sell or a revolutionary new norm? Inflamm Intest Dis. 2021 Jan 19;7(1):13-20. DOI: https://doi.org/10.1159/000515959

Avellaneda N, Maroli A, Tottrup A, et al. Short and long-term outcomes of surgery for inflammatory (uncomplicated) ileocecal Crohn’s disease: Multicentric retrospective analysis of 211 patients. Dig Liver Dis. 2024 May 1;56(5):730-6. DOI: https://doi.org/10.1016/j.dld.2023.10.017

Maggiori L, Panis Y. Laparoscopy in Crohn’s disease. Best Pract Res Clin Gastroenterol. 2014;28(1):183-94. DOI: https://doi.org/10.1016/j.bpg.2013.11.004

Bhattacharya P, Hussain MI, Zaman S, et al. Single-incision versus multi-port laparoscopic ileocolic resections for Crohn’s disease: Systematic review and meta-analysis. J Minim Access Surg. 2023 Oct 1 [;19(4):518-28. DOI: https://doi.org/10.4103/jmas.jmas_6_23

Gardenbroek TJ, Verlaan T, Tanis PJ, et al. Single-port versus multiport laparoscopic ileocecal resection for Crohn’s disease. J Crohns Colitis. 2013 Nov 1;7(10)e443-8. DOI: https://doi.org/10.1016/j.crohns.2013.02.015

Zaman S, Mohamedahmed AYY, Abdelrahman W, et al. Minimally invasive surgery for Inflammatory Bowel Disease: a systematic review and meta-analysis of robotic versus laparoscopic surgical techniques. J Crohns Colitis. 2024 Mar 11; epub ahead of print. DOI: https://doi.org/10.1093/ecco-jcc/jjae065

Crohn BB, Ginzburg L, Oppenheimer GD. Landmark article Oct 15, 1932. Regional ileitis. A pathological and clinical entity. JAMA. 1984 Jan 6;251(1):73-9. DOI: https://doi.org/10.1001/jama.251.1.73

Published

2024-09-11

How to Cite

1.
Gustavo Kotze P. The Role Of Upfront Surgery in the Management of Ileal Crohn’s Disease. Can IBD Today [Internet]. 2024 Sep. 11 [cited 2024 Nov. 21];2(2):5–9. Available from: https://canadianibdtoday.com/article/view/2-2-Gustavo_Kotze

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