title: The association between intensified medical treatment, time to surgery and ileocolic specimen length in Crohn's disease.
abstract: OBJECTIVE
  During the last decade, treatment protocols have changed for patients with ileocolic Crohn's disease. Anti-tumour necrosis factor (anti-TNF) has become part of standard medical treatment, usually in a step-up approach. The aim was to analyse if improved medical treatment has resulted in more limited ileocolic resections and a longer interval between diagnosis and surgery.
  
  
  METHODS
  Patients undergoing ileocolic resection for Crohn's disease were included (1999-2014). Patient characteristics were compared to the results of a population-based study (between 2004 and 2010) previously performed in the catchment area of the present tertiary referral centre. Time trends were analysed using the Cochrane-Armitage trend, Spearman's correlation coefficient and linear regression.
  
  
  RESULTS
  In total, 195 patients undergoing ileocolic resection were included. Patient characteristics were not significantly different from the background cohort, confirming a representative study group. Sixty-three patients were men (32.3%, median age at surgery 30.0 years, interquartile range 23.0-40.0). Anti-TNF and immunomodulator use prior to surgery increased significantly during the study period (χ2= 49.1, P < 0.001). Over the years, a significant increase in time from diagnosis to operation was found (median 39.0 months, interquartile range 12.0-86.0, rho 0.175, P = 0.014). The length of the resected ileum did not change significantly (median 20.0 cm, interquartile range 12.0-30.0, rho -0.107, P = 0.143). The number of fistulas or postoperative complications that needed re-intervention was not significantly different between the groups with or without anti-TNF.
  
  
  CONCLUSIONS
  This study demonstrated that over time patients with ileocolic Crohn's disease who eventually underwent ileocolic resection have been treated more intensively medically; however, this did not result in reduced specimen size.
authors.affiliation: Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.|Department of Gastroenterology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: E J
authors.initials: EJ
authors.lastname: de Groof
authors.affiliation: Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: T J
authors.initials: TJ
authors.lastname: Gardenbroek
authors.affiliation: Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: C J
authors.initials: CJ
authors.lastname: Buskens
authors.affiliation: Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: P J
authors.initials: PJ
authors.lastname: Tanis
authors.affiliation: Department of Gastroenterology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: C Y
authors.initials: CY
authors.lastname: Ponsioen
authors.affiliation: Department of Gastroenterology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: G R A M
authors.initials: GRAM
authors.lastname: D'Haens
authors.affiliation: Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: W A
authors.initials: WA
authors.lastname: Bemelman
mesh_terms: D000328:Adult; D003082:Colectomy / Q000379:methods / Q000706:statistics & numerical data*; D003106:Colon / Q000473:pathology / Q000601:surgery; D003131:Combined Modality Therapy; D003424:Crohn Disease / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006801:Humans; D007082:Ileum / Q000473:pathology / Q000601:surgery; D007155:Immunologic Factors / Q000627:therapeutic use; D016014:Linear Models; D008297:Male; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D055815:Young Adult
chemical_list: D005765:Gastrointestinal Agents; D007155:Immunologic Factors; D014409:Tumor Necrosis Factor-alpha
keywords: Crohn's disease; ileocolic resection; medical therapy