The importance of disease-free margins in resections for Crohn's disease

It has long been a fundamental principle of surgical therapy for Crohn's disease to remove all disease prior to doing an anastomosis. The authors recently noted with concern an article describing a series of patients demonstrating that residual involvement of anastomotic microscopic disease had no significant effect on the recurrence rate at the anastomosis. Examining their own series of 710 patients undergoing surgery for Crohn's disease, the authors found 42 patients with residual anastomotic disease. The criteria for involvement were more specific than that used in the above article and included microscopic mucosal disease. The recurrence rate within the follow-up period of eight years in patients with only microscopic involvement was 89.4 per cent. This was significantly higher than the institutional recurrence rate for Crohn's resections, previously reported, of 55 per cent at ten years. The authors feel that clear margins should be obtained in resections for Crohn's disease, if at all feasible.