Positive resection margins in Crohn's disease are a relevant risk factor for postoperative disease recurrence

Area of Science:

• Gastroenterology
• Surgical Oncology
• Pathology

Background:

• Postoperative recurrence of Crohn's disease (CD) remains a significant clinical challenge.
• Current risk stratification for CD recurrence lacks precision, necessitating improved predictive criteria.
• The impact of resection margins on CD recurrence is not well-defined, with a lack of consensus on surgical recommendations.

Purpose of the Study:

• To investigate the association between histopathological resection margin status and postoperative disease recurrence in Crohn's disease patients.
• To determine if resection margins are an independent risk factor for endoscopic and surgical recurrence following ileocecal resection for CD.

Main Methods:

• Retrospective analysis of 158 patients undergoing ileocecal resection for Crohn's disease.
• Histopathological evaluation of resection margins by two independent pathologists using established criteria.
• Assessment of postoperative morbidity, endoscopic recurrence (at 6 months and overall), and surgical recurrence with a median follow-up of 35 months.
• Multivariate analysis to identify independent risk factors for severe endoscopic recurrence.

Main Results:

• Positive resection margins were not associated with increased postoperative morbidity.
• Patients with positive margins showed significantly higher rates of severe endoscopic recurrence at 6 months (15.6% vs 2.0%) and overall (19.6% vs 4.2%).
• Positive margins also led to a significant increase in surgical recurrence (4.5% vs 0%).
• Positive resection margins were identified as an independent risk factor for severe endoscopic recurrence in multivariate analysis.

Conclusions:

• Positive resection margins are a significant independent risk factor for both endoscopic and surgical recurrence after ileocecal resection in Crohn's disease.
• Histopathological assessment of resection margins is crucial for identifying patients at higher risk of postoperative disease recurrence.
• Further prospective studies are warranted to evaluate the benefits of extended resection or postoperative prophylaxis in patients with positive margins.