Indications, postoperative management, and long-term prognosis of Crohn’s disease after ileocecal resection: a multicentre study comparing the East and West

Abstract

Abstract Background Crohn’s disease (CD) phenotype differs between Asian and Western countries and may affect disease management, including decisions on surgery. This study aimed to compare the indications, postoperative management, and long-term prognosis after ileocecal resection (ICR) in Hong Kong (HK) and The Netherlands (NL). Methods CD patients with primary ICR between 2000 and 2019 were included. The endpoints were endoscopic (Rutgeerts’ score ≥i2b and/or radiologic recurrence), clinical (start or switch of IBD medication) and surgical recurrences. Cumulative incidences of recurrence were estimated with a Bayesian multivariable proportional hazards model. Results Eighty HK and 822 NL patients were included. The most common indication for ICR was penetrating disease (HK 32.5%, NL 22.5%) in HK versus stricturing disease (HK 32.5%, NL 48.8%) in NL (P<0.001). Postoperative prophylaxis was prescribed to 65 (81.3%) HK (28 [35.0%] amino salicylates [5-ASA]; 30 [37.5%] immunomodulators [IM]; 0 biologicals) versus 388 (47.1%) NL patients (67 [8.2%] 5-ASA; 187 [22.8%] IM; 69 [8.4%] biologicals; 50 [6.1%] combination therapy, P<0.001). Endoscopic or radiologic evaluation within 18 months was performed in 36.3% HK versus 64.1% NL (P< 0.001) patients. No differences between both populations were observed for endoscopic (hazard ratio [HR]: 0.53 (95% confidence interval [CI]: 0.24–1.21), clinical (HR: 0.91 (95% CI: 0.62–1.32), or surgical (HR: 0.61 (95% CI: 0.31–1.13)) recurrence risks. Conclusion The main indication for ICR in CD patients is penetrating disease in HK patients and stricturing disease in NL patients. Although considerable pre- and post-operative management differences were observed between the two geographical areas, the long-term prognosis after ICR is similar.