Biologic Therapy and Surgical Management in Crohn’s Disease: Postoperative Outcomes and Biologic Management Patterns in a Retrospective Cohort Study

Background and Objectives: The therapeutic role of surgery in Crohn’s disease has evolved in the era of advanced biologic therapies, particularly in patients with complex and treatment-refractory disease. This study aimed to evaluate the relationship between preoperative biologic exposure and surgical outcomes, with a focus on predictors of more extensive surgical procedures, postoperative biological response, and postoperative biologic management. Materials and Methods: We conducted a retrospective cohort study including 60 patients with Crohn’s disease who underwent CD-related surgical interventions between January 2011 and December 2024. Clinical, surgical, and therapeutic data were collected. Combined resection procedures were defined as intestinal resections associated with additional surgical interventions. Postoperative biological response was defined as an exploratory composite endpoint reflecting the simultaneous normalization of hemoglobin, serum albumin, and C-reactive protein at six months. Statistical analyses, including univariable and multivariable methods, were performed. Results: Combined resection procedures were associated with advanced disease, particularly penetrating phenotypes and intra-abdominal sepsis, and with more frequent postoperative biologic intensification (OR 5.56, 95% CI: 1.05–29.57, p = 0.044). Postoperative biologic management included maintenance and intensification strategies (initiation or switching of biologic therapy). At six months, postoperative biological response was achieved in 20.7% of patients (12/58). No significant associations were observed between biological response and preoperative anti-TNF exposure or postoperative biologic intensification. Despite the relatively low rate of complete biological normalization, hemoglobin and albumin normalization were observed in 79.3% and 69.0% of patients, respectively, while the median fecal calprotectin decreased from 820 µg/g preoperatively to 130 µg/g at follow-up. Endoscopic remission was observed in 47.6% of patients with available SES-CD assessment. Conclusions: In patients with complex Crohn’s disease, surgical intervention remains an essential component of multidisciplinary management. While complete postoperative biological normalization was achieved in a limited proportion of patients, surgery was associated with consistent improvements in inflammatory and nutritional parameters. Further prospective studies are needed to better define predictors of postoperative recovery and to clarify the role of surgery within modern treatment algorithms.