Abstract
Background
Past research has identified different factors which are associated with post-operative recurrence of Crohn’s disease (CD). However, controversy remained whether the microscopic presence of CD in the margins of the resected specimen increases the risk of recurrence. The main aim of our study was to determine whether microscopic presence of CD in the resected specimen margin in patients who underwent ileocecal resection predicts disease recurrence. The secondary aim was to identify other risk factors for recurrence.
Methods
We retrospectively evaluated all CD patients who underwent ileocecal resection in our unit between 2000 and 2015. The diagnoses of CD and information regarding the margins’ involvement were retrieved from pathology reports. Recurrence was indicated according to medical records or according to specific phone questionnaire. Demographic and clinical parameters where compared between patients with and without histopathological evidence of CD in the resected margins.
Results
202 CD patients were included: 49 patients with histopathological evidence of CD in the resected margins and 153 patients without involvement. The main demographic characteristics were similar. Patients who received preoperative medical treatment had statistically significant higher rate of uninvolved margins (90.8 vs. 77.6%, p = 0.03). Technical aspects including surgical approach, conversion rates to open surgery, and anastomotic methods were similar. Likewise, the post-operative course regarding medical treatment, endoscopic and clinical recurrence, and reoperation rates was also similar.
We found a statistically significant shorter time for disease recurrence in laparoscopic surgery (HR 1.6, CI 1.1–2., p = 0.02(, stapled anastomosis (HR 1.7, CI 1.2–2.6, p = 0.01), if stricturoplasty was done in addition to the ileocecal resection (HR 1.7, CI 1.1–2.6, p = 0.02(, and in patients with perianal disease (HR 1.7, CI 1.1–2.6, p = 0.02(. Male gender and conversion from laparoscopic to open surgical technique had increased HR but did not reach statistical significance.
Conclusion
The presence of microscopic CD at the resection margins was not associated with disease recurrence. We found that male gender, perianal disease, laparoscopic approach, conversion to laparotomy and stapled anastomosis were associated with early disease recurrence. Our results support a conservative approach in the determination of the extent of resection in CD patients having ileocecal resection.
Canadian Association of Gastroenterology Clinical Practice Guideline for the Medical Management of Pediatric Luminal Crohn’s Disease
