OP34Long-term outcomes after appendectomy for maintenance of remission in ulcerative colitis: Five-year NL-results from the ACCURE randomized controlled trial.

Abstract Background The randomized controlled ACCURE trial showed that appendectomy significantly reduced clinical relapses within one year in patients with ulcerative colitis (UC) in remission without advanced therapies (biologicals and small molecules), compared with standard medical therapy alone1. We evaluated the long-term clinical effectiveness of laparoscopic appendectomy. Methods This long-term analysis included Dutch participants from the ACCURE trial. A modified intention-to-treat principle was used. Patients with missing follow-up data were excluded. Participants were prospectively followed for 5 years after randomization, with assessments every 6 months up to 5 years. The primary outcome was the initiation of advanced medical therapy. Secondary outcomes included colectomy and colorectal neoplasia. Time-to-event outcomes were analysed with Cox proportional hazard regression, adjusted for prespecified confounders (age, sex, smoking, disease extent and time since most recent exacerbation). Repeated binary outcomes (eg, advanced therapy use) were analysed using generalised estimating equation models. Results The Dutch cohort consisted of 170 patients. Seven patients were excluded (5 due to loss of follow-up; 2 due to reclassification as Crohn’s disease). A modified intention-to-treat population of 163 patients was analysed (80 appendicectomy group; 83 control). The median follow-up was 5 years IQR 5-5, and baseline characteristics were comparable; in the appendectomy group 53.8% were female, with a mean age of 42.2(SD 12.6) and a median disease duration of 5.0 IQR 1.9-11.8; in the control group 55.4% were female, with a mean age of 43.9 (SD 12.3) and a median disease duration of 5.2 IQR 1.5-11.3. The need for initiation of advanced medical therapy was significantly lower after appendicectomy than with medical therapy alone (8.8% 7/80 vs 25.3% 21/83 HR 0.33; 95% CI, 0.14-0.79; p = 0.012, adjusted HR 0.26; 95% CI, 0.10-0.64; p = 0.004). The median time to initiation of advance medical treatment was 24 months IQR 18-32 in the appendectomy group and 36 months IQR 10.5-48 in the control group. Three patients (1.8%) required colectomy, all-in the control group (0.0% vs 1.8%; p = 0.09). Dysplasia was incidentally found in the colectomy specimen of one patient. Conclusion In this 5-year follow-up study of the ACCURE-trial, appendicectomy was superior to medical therapy alone, with significantly fewer patients requiring escalation to advanced medical therapy. These findings underscore the long-term benefit of appendicectomy for maintenance of remission in UC, without evidence of an increased risk of neoplasia. Reference: 1. Visser, et al. Appendicectomy plus standard medical therapy versus standard medical therapy alone for maintenance of remission in ulcerative colitis (ACCURE): a pragmatic, open-label, international, randomised trial. the Lancet Gastroenterology 10(6):550-561. doi:10.1016/s2468-1253(25)00026-3 Conflict of interest: Van Dijk, Isabelle: No conflict of interest Visser, Eva: No conflict of interest D’Haens, Geert: No conflict of interest Bemelman, Willem: No conflict of interest Buskens, Christianne J.: No conflict of interest