Research in context
Evidence before this study
Treatment of patients with ileocaecal Crohn's disease in whom conventional therapy fails is commonly scaled up to biological agents. However, surgery can offer excellent short-term and long-term results. We searched PubMed and Embase from March 14–17, 2017, with the following terms: “laparoscopic ileocaecal resection”, “infliximab”, “anti-TNF”, Crohn's disease”, and “quality of life”. Publications in English between Jan 1, 1990, and Jan 1, 2017, were accepted.
Added value of this study
Effectiveness of laparoscopic ileocaecal resection and infliximab in restoring quality of life has previously been shown, but no randomised controlled trials had compared these strategies directly. We showed that laparoscopic ileocaecal resection did not improve quality-of-life scores to a significantly greater extent than infliximab treatment, but results in similar quality-of-life scores and is not associated with more serious adverse events. Long-term follow-up data indicated that more than a third of the patients who started on infliximab required an ileocaecal resection within a few years, whereas only one in four patients who initially had resection needed anti-TNF therapy later.
Implications of all the available evidence
Based on this trial, we conclude that laparoscopic ileocaecal resection is a reasonable alternative to infliximab in patients with limited, non-stricturing, ileocaecal Crohn's disease in whom conventional therapy fails.