Advancing perioperative optimization in Crohn's disease surgery with machine learning predictions

This editorial offers commentary on the article which aimed to forecast the likelihood of short-term major postoperative complications(Clavien-Dindo grade≥III),including anastomotic fistula,intra-abdominal sepsis,bleeding,and intestinal obstruction within 30 days,as well as prolonged hospital stays follow-ing ileocecal resection in patients with Crohn’s disease(CD).This prediction re-lied on a machine learning(ML)model trained on a cohort that integrated a no-mogram predictive model derived from logistic regression analysis and a random forest(RF)model.Both the nomogram and RF showed good performance,with the RF model demonstrating superior predictive ability.Key variables identified as potentially critical include a preoperative CD activity index≥220,low preope-rative serum albumin levels,and prolonged operation duration.Applying ML ap-proaches to predict surgical recurrence have the potential to enhance patient risk stratification and facilitate the development of preoperative optimization strate-gies,ultimately aiming to improve post-surgical outcomes.However,there is still room for improvement,particularly by the inclusion of additional relevant clinical parameters,consideration of medical therapies,and potentially integrating mole-cular biomarkers in future research efforts.

Endoscopic submucosal dissection for large laterally spreading tumors involving the ileocecal valve and terminal ileum

Endoscopic submucosal dissection is a challenging technique that enables en-bloc resection for large colorectal tumors, as laterally spreading tumors, particularly difficult, if the ileocecal valve and terminal ileum is involved. Herein, we report on one of 4 cases. The procedures, using a bipolar needle knife (B-Knife) to reduce the perforation risk and carbon dioxide instead of conventional air insufflation for patient comfort, achieved curative resections without any complications.

What constitutes failure of medical therapy in the changing landscape of Crohn's disease?

The management of Crohn's disease has evolved rapidly in the era of immunomodulators and biologicals.Despite this,a significant proportion of patients with Crohn's disease ultimately require surgical management.One of the indications for operative management includes failure of medical therapy.We report two cases of patients with complicated Crohn's disease who have exhausted medical therapy and failed medical management.In both cases,the patients developed large complex intra-abdominal phlegmons and intractable symptoms of intermittent pain,partial obstruction and/or infectious complications requiring operative intervention.Crohn's disease can present with a wide spectrum of disease.Considering the complexity of management in Crohn's disease,it is important for both physicians and surgeons to be aware of what constitutes failure of medical therapy and when it may be important to consider surgical involvement.