LIR!C Trial: Lancet Gastroenterol Hepatol, 2026

Introduction

Management of localised ileocaecal Crohn’s disease traditionally prioritises medical therapy, particularly anti-TNF agents such as infliximab. However, the original LIR!C randomised trial demonstrated that laparoscopic ileocaecal resection could be an effective alternative to infliximab, providing comparable quality-of-life outcomes in patients with immunomodulator-refractory, non-stricturing ileal Crohn’s disease. Given the increasing interest in early surgical intervention as a disease-modifying strategy, the present study evaluated the long-term (10-year) outcomes of patients enrolled in the LIR!C trial, focusing on therapy-free remission and sustained clinical remission.

Summary

This retrospective follow-up study included 129 patients (90%) from the original LIR!C randomised trial, with 66 patients undergoing ileocaecal resection and 63 receiving infliximab therapy. The median follow-up duration was 11 years.

The 10-year therapy-free remission rate was significantly higher in the surgical group compared with the infliximab group:

35.8% after ileocaecal resection

13.2% after infliximab

(difference 22.6%, p=0.0038)

Despite this difference, the overall clinical remission rates at 10 years were similar between groups:

36.5% with surgery vs 28.4% with infliximab (HR 0.79; p=0.27).

Exploratory analyses suggested an age-dependent effect, with younger patients benefiting more from early surgery. For example, the estimated 10-year clinical remission was 54% in a 20-year-old patient undergoing resection vs 24% with infliximab.

Conclusion

Long-term results from the LIR!C cohort show that ileocaecal resection provides significantly higher therapy-free remission rates than infliximab, while overall clinical remission remains comparable. These findings support early laparoscopic ileocaecal resection as a viable and potentially advantageous treatment option in selected patients with localised ileal Crohn’s disease, particularly in younger individuals.