P0645Early ileocecal resection versus prolonged biologic therapy in Crohn’s disease: a real-life comparative study on long-term outcomes

Abstract Background The optimal therapeutic strategy for localized ileocecal Crohn’s disease (CD) remains controversial. While biologic therapy represents the cornerstone of modern management, early surgical intervention may achieve durable remission and reduce cumulative drug exposure. This study aimed to compare long-term outcomes of early ileocecal resection versus prolonged biologic therapy in real-life patients with localized CD. Methods We retrospectively analyzed patients with non-stricturing, non-penetrating ileocecal CD diagnosed between 2016 and 2024 in a tertiary referral center. Patients were categorized into two groups: 1. Surgical group (EARLY SURGERY): ileocecal resection performed within 18 months of diagnosis, before or after short induction therapy; 2. Biologic group (MEDICAL): at least one year of continuous biologic therapy without surgery. Primary endpoint: clinical remission at 24 months. Secondary endpoints: steroid-free remission, hospitalization, complications, and quality of life (IBDQ score). Propensity score matching was applied to minimize selection bias. Results The study included 28 patients in the surgery group and 48 in the biologic group. At 24 months, clinical remission was achieved in 81% of the surgical group vs 63% of the biologic group (p = 0.02). Steroid-free remission was higher after early surgery (76% vs 52%, p = 0.01), and hospitalization rates were lower (9% vs 27%, p = 0.03). No significant difference in overall quality of life was observed. Adverse events were more frequent in the biologic group (21% vs 7%, p = 0.04). During follow-up, 14% of operated patients required biologic therapy, while 29% of biologically treated patients required delayed surgery. Conclusion Early ileocecal resection in localized CD may provide superior long-term remission and fewer hospitalizations compared to prolonged biologic therapy alone. A multidisciplinary, individualized “surgery-first” approach could represent a valid alternative in selected patients with limited ileocecal disease and low risk for extensive recurrence. Conflict of interest: Dr. Cristina, Tocia: No conflict of interest Dina, Elena: No conflict of interest Dumitru, Andrei: No conflict of interest Rafti, Raluca: No conflict of interest Popescu, Ioana: No conflict of interest Alexandrescu, Luana: No conflict of interest Dumitru, Eugen: No conflict of interest