DOP042 Need for ileocaecal resections, but not ileo-colic re-resections, has decreased: a nationwide study of temporal trends in Crohn surgery in Sweden 1990–2014

Abstract

During the last two decades, medical therapy for Crohn’s disease (CD) has been rapidly evolving with the aim of preventing complications necessitating surgery. Some population-based studies have shown decreasing surgical rates preceding modern medical therapy but data are conflicting. According to earlier studies about 50% of the patients would need an ileocaecal resection within 10 years and of these 50% would have a re-resection within another 10 years. All incident CD patients in Sweden (≥2 diagnostic listings) 1990 to 2014 were included in this nationwide register-based cohort study. Patients with prior abdominal surgery (except appendectomy) or any perianal surgery 2 years prior of CD diagnosis were excluded, and the final cohort consisted of 19648 individuals. The cumulative incidences of surgeries were calculated using the Kaplan–Meier method. The population was divided into five different cohorts depending on time period of diagnosis and inclusion. The cumulative incidence of ever being treated with ileocaceal resection within 5 years of CD diagnosis was 36% and 29% during the time periods 1990–1995 and 1996–2000 and after the millenium 14%, 12% and 10% for the patients diagnosed 2001–2003, 2004-2009 and 2010–2014 respectively. The cumulative incidence for ileocaecal resection within 10 years were 40% and 35% for the two first cohorts and 17% and 16% for the cohorts diagnosed 2001–2003 and 2004–2009. The cumulative incidence of an ileocolic re-resection was 6% and 5% 5 years following the primary resection among those diagnosed 1990–1995 and 1996–2000. The cohorts after the millenium had the same rate of ileocolic re-resections after 5 years of 5% as the patients diagnosed 1996–2000. Cumulative incidence of first ileocaecal resection during all available follow-ups of 19648 patients with Crohn’s disease. Cumulative incidence of second ile colic resection during all available follow-ups of 4119 patients with Crohn’s disease. In this nationwide study of virtually complete registers with prospectively recorded real-life data, we found the risk of both primary and secondary ileocecal resection to be considerably lower than previously reported. The cumulative incidence of an ileocaecal resection within 5 and 10 years was 10% and 5% in the most recent calendar periods respectively. The need of a second ileocolic resection was as low as 5% after 5 years but with no significant temporal changes seen over the time period 1990–2014, in spite of more than a decade with more potent and costly treatment available.