The Influence of Microscopic Inflammation at Resection Margins on Early Postoperative Endoscopic Recurrence After Ileocaecal Resection for Crohn’s Disease

Abstract

Background and Aims The pathogenesis and risk factors for early postoperative endoscopic recurrence of Crohn’s disease [CD] remain unclear. Thus, this study aimed to identify whether histological inflammation at the resection margins after an ileocaecal resection influences endoscopic recurrence. Methods We have prospectively followed up patients with CD who underwent ileocaecal resection at our hospital between January 2012 and January 2018. The specimens were histologically analysed for inflammation at both of the resection margins [ileal and colonic]. We evaluated whether histological results of the resection margins are correlated with endoscopic recurrence of CD based on colonoscopy 6 months after ileocaecal resection. Second, we assessed the influence of known risk factors and preoperative therapy on endoscopic recurrence of CD. Results A total of 107 patients were included in our study. Six months after ileocaecal resection, 23 patients [21.5%] had an endoscopic recurrence of CD. The histological signs of CD at the resection margins were associated with a higher endoscopic recurrence [56.5% versus 4.8%, p < 0.001]. Disease duration from diagnosis to surgery [p = 0.006] and the length of the resected bowel [p = 0.019] were significantly longer in patients with endoscopic recurrence. Smoking was also proved to be a risk factor for endoscopic recurrence [p = 0.028]. Conclusions Histological inflammation at the resection margins was significantly associated with a higher risk of early postoperative endoscopic recurrence after an ileocaecal resection for CD.

The Revival of Surgery in Crohn’s Disease—Early Intestinal Resection as a Reasonable Alternative in Localized Ileitis

“…Different studies demonstrated a significantly increased risk for endoscopic recurrence following ileocecal resection in case of microscopic inflammation at the resection margins. Following ileocecal resection, Poredska et al showed that 56.5% of patients with positive resection margins suffered from endoscopic recurrence after six months in comparison to 4.8% with noninflamed resection margins (p < 0.001) [80]. Furthermore, another study from France confirmed an increased risk of clinical and surgical recurrence after resection in case of a positive histological margin.…”

Surgical Strategies to Reduce Postoperative Recurrence of Crohn's Disease After Ileocolic Resection

“…While the evidence is equivocal, it appears that overall the majority of publications favour the theory that histologically involved margins do not increase the risk of recurrence after ileocolic resection for CD (34)(35)(36). It is worth noting that the topic has continued to be investigated and some recent studies, including a meta-analysis, have again suggested that an association exists between histologically positive margins and recurrence (37,38). There still remains issues with how histological margin positivity and recurrence are reported.…”

Medical therapies for postoperative Crohn’s disease

“…Histologic risk factors, including positive margins of resection, plexitis, lymphatic vessel density, and morphologic analysis of Paneth cells, may predict POR. 85,86 Finally, microbiome dysbiosis is being recognized as a risk factor with recolonization of microbiota, including Proteobacteria, Akkermansia spp., Fusobacteriaceae and a depletion of Streptococcaceae, Actinomycineae, Faecalibacterium. [35][36][37] Interestingly, active smoking was associated with elevated levels of Proteus, 37 and thus these risk factors may be interactive.…”