Crohn’s Disease Surgery Outcomes Show Limited Progress With Advanced Therapies
New study finds stable repeat surgery rates despite wider use of biologics and small molecules
A Dutch study following Crohn’s disease patients for over 20 years found that about 12% required a third surgery within five years of their second, despite greater use of biologics and small-molecule therapies. Advanced therapies did not reduce the risk of further surgery.
Study Details
Crohn’s disease often leads to surgery, with nearly one third of patients undergoing a major abdominal procedure such as ileocolic resection within five years of diagnosis. Recurrence at the neoterminal ileum frequently drives additional operations, but the long-term effect of newer drug strategies has been unclear.
Researchers at Amsterdam University Medical Center retrospectively analyzed data from 110 adults who had a second surgery between 2000 and 2021. The median age was 39, and about 63% were women. Patients were divided into two cohorts based on whether their second surgery occurred between 2000–2009 or 2010–2021.
Methodology
Design: Single-center, retrospective analysis
Population: 110 Crohn’s patients with prior second surgery
Therapies tracked: Biologics (e.g., anti-TNF agents) and small molecules (e.g., upadacitinib)
Outcome: Need for a third surgery due to disease recurrence at the anastomotic site or neoterminal ileum
Follow-up: Median of 126 months
Key Findings
Over a median follow-up of more than 10 years, about 12% of Crohn’s disease patients required a third surgery within 5 years of their second procedure, and nearly one in four needed a third operation within 10 years. Most of these repeat surgeries (77%) were driven by stricturing disease rather than inflammatory recurrence.
Importantly, the use of advanced therapies such as biologics and small molecules increased significantly between 2000 and 2021, yet this did not translate into a lower risk of repeat surgery. Patients who had previously been treated with immunomodulators or advanced therapies before their second surgery actually showed a higher likelihood of needing a third, suggesting that those with more aggressive disease may not gain surgical protection from these therapies.
Implications for Practice
Despite evolving postoperative strategies including immunomodulators, anti-TNF therapy, small molecules, and closer endoscopic monitoring recurrence requiring surgery has not declined over two decades.
For patients, this highlights the persistent need for careful long-term monitoring even when on advanced therapies.
For providers, it emphasizes that while biologics and small molecules improve many aspects of Crohn’s management, they may not prevent repeat surgeries after recurrence.