Laparoscopic ileocolic resection versus infliximab treatment of distal ileitis in Crohn's disease: a randomized multicenter trial (LIR!C-trial)

Eshuis, Emma J.; Bemelman, Willem A.; Bodegraven, Ad A. van; Sprangers, Mirjam A. G.; Bossuyt, Patrick M.; Wit, A.W.M. van Milligen de; Crolla, Rogier M. P. H.; Cahen, Djuna L.; Oostenbrug, Liekele E.; Sosef, Meindert N.; Voorburg, A.; Davids, P. H. P.; Woude, Christien J. van der; Lange, J; Mallant, Rosalie C.; Boom, Maarten J.; Lieverse, R. J.; Zaag, Edwin S. van der; Houben, Martin H.; Vecht, J. van der; Pierik, Robert; Ditzhuijsen, Theo J.M. van; Prins, Hubert A.; Marsman, Willem A.; Stockmann, H.B.A.C.; Brink, Menno A.; Consten, Esther C. J.; Werf, S. D. J. Van Der; Marinelli, A.; Jansen, Jeroen M.; Gerhards, Michael F.; Bolwerk, Clemens; Stassen, Laurents P. S.; Spanier, B.W.M.; Bilgen, Ernst Jan Spillenaar; Berkel, Anne-Marie van; Cense, Huib A.; Heukelem, H. A. van; Laar, Arnold van de; Slot, W. Bruins; Eijsbouts, Q. A. J.; Ooteghem, Nancy Am; Wagensveld, Bart A. van; Brande, Jan M. H. van den; Geloven, A. A. W. van; Bruin, Karien F; Maring, John K.; Oldenburg, Bas; Hillegersberg, Richard van; Jong, Dirk J. de; Bleichrodt, Robert P.; Peet, Donald L. van der; Dekkers, P.; Goei, T Hauwy; Stokkers, Pieter

doi:10.1186/1471-2482-8-15

Cited by 32 publications

(12 citation statements)

References 27 publications

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“…Lastly, the role of intestinal resection amidst the growing trend toward early introduction of biologic agents in patients at high risk of disabling disease is less clear [53] . Findings from the LIR!C trial may help elucidate the appropriate timing of surgery [54] .…”

Section: Implications For Future Researchmentioning

confidence: 99%

Quality of Life after Intestinal Resection in Patients with Crohn Disease: A Systematic Review

Ha¹,

Thong²,

Khalil³

2017

Dig Surg

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Background/Aims: Most patients with Crohn disease (CD) require surgery within 10 years of diagnosis. Intestinal resection is the most commonly performed operation although the effects on health-related quality of life (HRQOL), particularly long-term, are contentious. Methods: We conducted a systematic review evaluating the impact of intestinal resection on the HRQOL of CD patients, predictors of postoperative HRQOL, and patient satisfaction with surgery. Results: Nine studies including 1,108 CD patients undergoing intestinal resection were identified as eligible for inclusion. The median age at surgery was 29-41 years with varying follow-up period (range 30 days-5 years). Ileocolic resection was the most commonly performed operation on an elective basis (range 95-100%). HRQOL improved as early as 2 weeks postoperatively and lasted up to 5 years across both generic and gastrointestinal domains. Gender, smoking, and disease recurrence were potential predictors of postoperative HRQOL. Patient satisfaction is high with regard to surgery, with preference for a laparoscopic approach. Conclusion: Intestinal resection in CD patients improved HRQOL in the short- and long-term and patients describe high satisfaction about their surgery. Further studies are needed to validate potential predictors of postoperative HRQOL in this cohort.

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Section: Implications For Future Researchmentioning

confidence: 99%

Quality of Life after Intestinal Resection in Patients with Crohn Disease: A Systematic Review

Ha¹,

Thong²,

Khalil³

2017

Dig Surg

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“…31 We believe that this study, although underpowered, supports the view, presented by, among others, the ECCO committee, 32 that surgery is a treatment option for ileocaecal CD and not just a last resort when medical treatment fails, and the management of CD requires a joint effort by medical gastroenterologists and surgeons. More studies of treatment alternatives including surgery are needed and important results may come from the ongoing multicentre LIR!C trial 33 comparing laparoscopic ileocaecal resection with biologics in newly diagnosed CD.…”

Section: Discussionmentioning

confidence: 99%

The Swedish Crohn Trial: A Prematurely Terminated Randomized Controlled Trial of Thiopurines or Open Surgery for Primary Treatment of Ileocaecal Crohn’s Disease

Gerdin

Eriksson

Olaison³

et al. 2015

ECCOJC

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Background and aims: The importance of efficient and safe treatment of Crohn's disease is highlighted by its chronicity. Both medical and surgical treatments have shown good results in the symptomatic control of limited ileocaecal Crohn's disease. The aim of this study was to compare medical treatment with surgical treatment of ileocaecal Crohn's disease. Methods: Thirty-six patients from seven hospitals with primary ileocaecal Crohn's disease were randomized to either medical or surgical treatment. The medical treatment was induction of remission with budesonide and thereafter maintenance treatment with azathioprine. The surgical treatment was open ileocaecal resection. Crohn's disease activity index over time, expressed as area under the curve at 1, 3 and 5 years, was the primary endpoint. Subjective health measured with the 36-item Short Form Survey Instrument (SF36) and a visual analogue scale (VAS) were secondary endpoints. Results: There were no differences between the treatment groups in Crohn's disease activity index over time. General health, measured as SF36 score, was higher in patients receiving surgical treatment than in those receiving medical treatment at 1 year, but there was no corresponding difference in VAS. Due to the slow inclusion rate and changes in clinical practice, the study was t=erminated prematurely. Conclusion: The study ended up being underpowered and should be interpreted with caution, but there was no clinically significant difference between the two treatment arms. Further studies are needed to address this important clinical question.

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“…However, an ongoing randomized controlled trial (RCT) comparing infliximab with surgi cal resection in refractory Crohn's disease should help to clarify this indication. 10 Surgical indications for acute small bowel Crohn's disease are scarce. Free perforation can lead to peritonitis, but this complication is rare, with reported prevalence rates of 1-4%.…”

Section: Small Bowel Crohn's Diseasementioning

confidence: 99%

Surgical management of IBD—from an open to a laparoscopic approach

Maggiori

Panis

2013

Nat Rev Gastroenterol Hepatol

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Surgery is a key feature of IBD management. Up to 70% of patients with Crohn's disease and 35% of patients with ulcerative colitis will require surgery during the course of their disease. This Review provides an overview of IBD surgical management, focusing on the potential benefits and drawbacks of laparoscopy compared with open surgery. Emergency and elective indications for both laparoscopic and open surgery are detailed for patients with ulcerative colitis and Crohn's disease. Evidence-based comparative results of these surgical approaches are discussed, along with factors that influence patient outcomes. Upcoming new techniques for IBD surgical management, including single-port surgery, are also presented.

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Laparoscopic ileocolic resection versus infliximab treatment of distal ileitis in Crohn's disease: a randomized multicenter trial (LIR!C-trial)

Cited by 32 publications

References 27 publications

Quality of Life after Intestinal Resection in Patients with Crohn Disease: A Systematic Review

Quality of Life after Intestinal Resection in Patients with Crohn Disease: A Systematic Review

The Swedish Crohn Trial: A Prematurely Terminated Randomized Controlled Trial of Thiopurines or Open Surgery for Primary Treatment of Ileocaecal Crohn’s Disease

Surgical management of IBD—from an open to a laparoscopic approach

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