Timing of ileocolic resection for Crohn's disease: A survey of the patient perspective in the ‘biological’ era

BACKGROUND: Medical therapy is often favoured in the treatment of ileocaecal Crohn's disease (CD), with surgery often reserved for treatment failure. Data from the 'pre-biological' era suggest that most patients who had an ileocolic resection for CD would have preferred to have surgery sooner. We revisited this observation in the current era and assessed decision-regret relating to surgery. METHODS: A multicentre cross-sectional survey was conducted across nine centres in the United Kingdom with adult patients who had their first ileocolic resection for isolated terminal ileal or ileocolic CD in the 7 years preceding the study. Primary outcomes were patient preference for timing of resection and decision-regret scale score (DRS). RESULTS: Data from 171 completed surveys were analysed. Eighty (46.8%) patients were satisfied with the timing of surgery; 43.2% (74/171) wished they had surgery sooner and experienced a higher proportion of open procedures. The median DRS was 5/100. The only significant predictor of regret was a lower degree of involvement in shared decision-making (SDM). Nearly half believed surgery to only be an option after all medical therapies had failed. CONCLUSION: The proportion who felt that their resection was left too late (43%) is still significant, despite being lower compared to the 'pre-biological' era (75% in a previous similar study). Patients' regret relating to their first resection is generally low, especially when they are involved in SDM. However, SDM remains suboptimal. There is an urgent need for improved counselling and earlier surgical consideration in isolated ileocaecal CD, supported by multidisciplinary input.