Early surgery in Crohn’s disease a benefit in selected cases

Table 1 Demographic and clinical data n (%)

		Initial medical therapy (n = 115)
Clinical details	Early surgery (n = 42)	IMT (n =115)	P value	DS (n = 62)1	P value
Gender M:F	22:20	50:65	0.531	24:38:00	0.227
Age at diagnosis (yr), median (IQR)	34.5 (24-46)	24 (19-33)	0.0001	23.5 (18.25-31.75)	0.006
Smoking	15 (35.7)	43 (37.4)	0.852	25 (40.3)	0.685
Phenotype
B1 (non-stricturing)	3 (7.1)	38 (36.2)	0.001	4 (6.5)	0.968
B2 (stricturing)	17 (40.5)	26 (24.8)		24 (38.7)
B3 (penetrating)	22 (52.4)	41 (39.0)		34 (54.8)
Location
L1 (ileal)	28 (66.7)	25 (24.5)	0.0001	17 (26.3)	0.0001
Perianal disease	0	6 (5.2)		3 (4.8)
L3 (ileocolonic)
Perianal disease	14 (33.3)	74 (69.4)		45 (70.2)
	5 (11.9)	40 (34.8)		16 (25.8)

¹Patients in the DS group are a subset of IMT patients. IMT: Initial medical therapy; DS: Deferred surgery; IQR: Interquartile range; M: Male; F: Female.

Table 2 Indications for early surgery n (%)

Clinical details	Early surgery (n = 42)	Deferred surgery (n = 62)
Indication for surgery
Acute obstruction – emergency resection	9 (21.4)	4 (23.0)
Subacute obstruction – elective resection	-	20 (32.3)
Perforation	15 (35.7)	7 (11.3)
Fistula/phlegmon	5 (11.9)	15 (24.2)
Abdominal pain	5 (11.9)	2 (3.2)
Haemorrhage	3 (7.1)	-
Not specified	5 (11.9)	14 (23.0)

Table 3 Comparison of early vs initial medical therapy in Crohn’s disease n (%)

		Initial medical therapy (n = 115)
Clinical details	Early surgery (n = 42)	Initial medical therapy (n = 115)	P value	Deferred surgery (n = 62)1	P value
Number requiring surgery
3 yr	5 (11.9)	24 (20.7)	0.250	5 (8.1)	0.521
5 yr	6 (14.2)	36 (31.3)	0.041	10 (16.1)	NS
Completion of study period	7 (16.7)	62 (53.9)	< 0.0001	20 (32.3)	0.110
Number of admission to hospital per patient, median (IQR)	1 (1-2)	3 (1-5)	0.012	2 (1-4.5)	0.002
Days in hospital (d), median (IQR)	12.5 (9-22.5)	11 (3-28)	0.230	17 (8-28)	0.347
Medical therapy
Immune modulator	32 (76.2)	101 (87.8)	0.083	54 (87.1)	0.189
Steroids	12 (28.6)	34 (29.6)	NS	23 (37.1)	0.404
Anti-TNF	14 (33.3)	69 (60.0)	0.004	42 (67.7)	0.001
No requirement for medical therapy	10 (23.8)	5 (4.3)	0.008	0 (0)	< 0.0001
Follow-up months (mo), median (IQR)	67 (31-114)	97 (58-150)		64 (19-121)

¹Data for this subset regarding length of stay and hospital admissions was taken from the date of first operation and not from date of diagnosis. IQR: Interquartile range; TNF: Tumour necrosis factor; NS: Not significant.

Table 4 Comparison of extent of resection performed in early surgery vs deferred surgery cohorts n (%)

Clinical details	Early surgery (n = 42)	Deferred surgery (n = 62)	P value
Operation
Small bowel resection	5 (11.9)	7 (11.3)	NS
Ileocolic resection	31 (73.8)	30 (48.4)	0.015
Small bowel and segmental colonic resection	3 (7.1)	9 (14.5)	0.352
Small bowel and total colectomy	2 (4.8)	9 (14.5)	0.193
Data unavailable	1 (2.9)	7 (11.3)	0.139
Stoma formation	3 (7.1)	5 (8.1)	NS

NS: Not significant.