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Positive histologic margins is a risk factor of recurrence after ileocaecal resection in Crohn’s disease - 14/11/20

Doi : 10.1016/j.clinre.2020.10.013 
Clementine Riault a, Momar Diouf b, Denis Chatelain c, Clara Yzet a, Justine Turpin a, Franck Brazier a, Jean-Louis Dupas a, Charles Sabbagh d, Eric Nguyen-Khac a, Mathurin Fumery a,
a Gastroenterology, Amiens University and Hospital, Université de Picardie Jules Verne, Amiens, France 
b Pathology Unit, Amiens University and Hospital, Université de Picardie Jules Verne, Amiens, France 
c Department of Biostatistics, University Hospital of Amiens, Amiens, France 
d Digestive Surgery, Amiens University and Hospital, Université de Picardie Jules Verne, Amiens, France 

Corresponding author at: Service Hépato-Gastroentérologie, CHU Amiens Picardie Université de Picardie Jules Verne Site Sud - D408, 80054 Amiens, France.Service Hépato-GastroentérologieCHU Amiens Picardie Université de Picardie Jules Verne Site Sud - D408Amiens80054France
Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Saturday 14 November 2020

Highlights

Surgical resection is not curative in Crohn’s disease (CD) and, recurrence after surgery is a common situation.
The impact of residual microscopic disease on margins on the risk of recurrence after ileocaecal resection in CD is still subject to debate.
The presence of acute inflammatory lesions on margins was as associated with an increased risk of clinical and surgical recurrence.
Positive resection margins should be included as a risk factor in current algorithms of postoperative prevention recurrence management.

Le texte complet de cet article est disponible en PDF.

Abstract

Introduction

Surgical resection is not curative in Crohn’s disease (CD) and, recurrence after surgery is a common situation. The identification of patients at high risk of recurrence remains disappointing in clinical practice.

Objective

To evaluate the impact of residual microscopic disease on margins on the risk of recurrence after ileocaecal resection in CD.

Patients and methods

All patients who underwent ileocaecal resection between January 1992 and December 2016 were prospectively identified. Demographic data, clinical, surgical and histological variables were retrospectively collected. Positive histologic margin was assessed prospectively and defined by the presence of acute inflammatory lesions on margins: erosion, ulceration, chorion infiltration by neutrophils, cryptic abscesses or cryptitis.

Results

One hundred twenty five patients were included, with a median follow-up of 8 years (Interquartile Range (IQR), 4.3–15.2). Half (49.6%, n = 62) were women, and the median age at surgery was 33 years (IQR, 24–42). Fifty-six (44.8%) had positive inflammatory margins. Five years after surgery, respectively 29 (51%) and 23 (34%) patients with positive and negative margins had clinical recurrence (p = 0.034). At the end of the follow-up, respectively 60% (n = 34) and 47% (n = 33) patients had clinical recurrence (p = 0.07). CD-related hospitalizations were observed in respectively 37.5% (n = 21) and 18.8% (n = 13) with positive and negative margins (p = 0.02). Fourteen patients (25%) with positive intestinal margins had surgical recurrence at the end of the follow-up compared to 5 patients (7%) with negative margins (p = 0.04). Multivariate analysis confirmed that positive intestinal margin was independently associated with surgical recurrence (OR, 4.7 (CI95%, 1.4–15.3), p = 0.01).

Conclusion

Positive histologic margin was associated with an increased risk of clinical and surgical recurrence after ileocaecal resection for Crohn’s disease.

Le texte complet de cet article est disponible en PDF.

Keywords : Crohn’s disease, Margins, Postoperative recurrence


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