S1882 Long-Term Comparative Outcomes of Early Ileocolic Resection vs Anti-TNF Therapy in Crohn’s Disease Patients

Introduction: Anti-tumor necrosis factor (TNF) therapy remains integral for the management of Crohn’s disease (CD). However, recent evidence, such as the Laparoscopic Ileocolonic Resection Versus Infliximab Treatment of Recurrent Distal Ileitis in Crohn’s Disease trial, shows that early surgical intervention, particularly ileocolonic resection (ICR), may provide similar or even superior outcomes, along with decreased long-term dependence on pharmacologic therapy. This study evaluated long-term clinical outcomes among CD patients treated with early ICR vs early initiation of anti-TNF therapy within one year of diagnosis. Methods: A retrospective, propensity score-matched cohort study was conducted using TriNetX Global Collaborative Network. We compared 7,357 patients undergoing early ICR with an equal number of patients initiating anti-TNF therapy within one year of CD diagnosis. Matching controlled for demographics, comorbidities, and baseline medication use. The primary composite outcome included all-cause hospitalization, steroid use, escalation of Crohn’s therapy, and bowel surgery. Secondary outcomes individual components of primary outcomes, perianal disease, intestinal obstruction, and emergency department (ED) visits. Outcomes were evaluated over a 10-year follow-up period. Risks, risk differences, odds ratios (ORs), and 95% confidence intervals (CIs) were reported. Results: The ICR group showed a significantly lower risk of the primary composite outcome (48.6% vs 58.2%; OR 0.68, CI 0.64–0.72; P < 0.001). ICR was also associated with reduced risk of biologic escalation (12.2% vs 15.7%; OR 0.74; P < 0.001), small molecule escalation (0.7% vs 2.0%; OR 0.35; P < 0.001), steroid use (31.8% vs 48.8%; OR 0.49; P < 0.001), and perianal disease (3.0% vs 6.7%; OR 0.44; P < 0.001). However, ICR was associated with higher rates of bowel surgery (4.0% vs 2.1%; OR 1.92; P < 0.001), all-cause hospitalization (30.4% vs 25.4%; OR 1.28; P < 0.001), and ED visits (28.7% vs 26.6%; OR 1.11; P = 0.004). No statistically significant difference was observed in the development of intestinal obstruction (13.9% vs 12.9%; P = 0.086). Conclusion: Among Crohn’s disease patients, early ICR is associated with significantly reduced long-term corticosteroid use, therapy escalation, and perianal complications compared to early anti-TNF therapy. While it carries a higher risk of repeat surgery and hospitalizations, these findings support early surgical resection as a viable therapeutic option in selected patients.