Terminal Ileum Resection in Crohn’s Disease Linked to Increased Colorectal Cancer Risk
Patients with Crohn’s disease (CD) who undergo terminal ileum (TI) resection face a significantly increased risk of colorectal cancer (CRC), according to findings from a large propensity-matched cohort study using the TriNetX database. The study highlights a critical need for intensified colorectal cancer surveillance in this patient population.
Researchers compared CRC outcomes between patients with CD who underwent TI resection and those who did not. The adjusted hazard ratio (aHR) for CRC was 2.58 (95% CI, 1.72–3.86), indicating more than double the risk among patients with a history of TI resection.
“Terminal ileum resection was associated with an increased risk of CRC,” the authors stated, emphasizing the relevance of surgical history when assessing long-term cancer risk in patients with CD.
In addition to CRC, the study also found that patients with TI resection had higher odds of developing colorectal polyps, a known precursor to malignancy. These findings suggest that changes in bile acid metabolism following TI resection may contribute to carcinogenic processes in the colon.
The results underscore the importance of proactive risk stratification and surveillance. Current colorectal cancer screening guidelines for patients with inflammatory bowel disease may need to be reconsidered for those who have undergone TI resection.
“These findings suggest the need for heightened CRC surveillance in patients with CD undergoing TI resection,” the authors concluded.
For practicing gastroenterologists, this study supports incorporating surgical history into surveillance protocols and potentially initiating CRC screening at an earlier stage or at increased frequency in post-resection patients with CD. Further studies are warranted to explore the underlying mechanisms and to refine screening strategies based on individualized risk.
Reference
Mikhail I, Al Ta'ani O, Aburumman R, Alsakarneh S, Farraye FA, Hashash JG. Patients with crohn's disease and terminal ileum resection are at increased risk of colorectal cancer: a population-based study. Inflamm Bowel Dis. Published online June 18, 2025. doi:10.1093/ibd/izaf118
