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P211. The presence of microscopic disease at the resection margins predicts post-surgical relapse in Crohn's disease

J. Kinchen1, K. Rajaratnam2, G. Kingston2, A. Mee1, A. De Silva1

1Royal Berkshire Hospital NHS Foundation Trust, Gastroenterology, Reading, United Kingdom; 2Royal Berkshire Hospital NHS Foundation Trust, Histopathology, Reading, United Kingdom

Background: Around 80% of patients with Crohn's disease will require surgery, and the rate of recurrence post surgery is high. The influence of microscopic disease at the resection margins on the rate of recurrence has been evaluated retrospectively with disparate results [1,2]. Current surgical practice is to resect only to the extent of gross macroscopic involvement.

Presented here is a series of 238 resections performed at a single centre between 1993 and 2004. Time to post-operative relapse is compared between groups with and without residual disease at the margins.

Methods: The histology reports from all bowel resections performed for Crohn's disease were reviewed for evidence of microscopic disease at the margins. If a further resection specimen with evidence of active Crohn's was received within 5 years of the index surgery, that patient was deemed to have experienced a relapse. Kaplan–Meier survival analysis was performed and hazard functions compared using the logrank test.

Results: Microscopic marginal involvement was found in 125 specimens, while 75 had clear margins. In 38 specimens the status of the margins was not recorded.

The baseline characteristics of the groups with involved and clear margins
 Margins involvedMargins clearp value
Number125 75 
Mean age39.8 39.5 0.91
Resection type    
 Small bowel3628.81418.70.13
Completed follow up    
 6 months11592.07093.30.79
 5 years6350.44661.30.14

There were 20 relapses following resections with marginal involvement (16%), compared to 2 relapses for resections with clear margins (2.7%). The difference is significant (hazard ratio 9.53, p = 0.002).

Surgery-free post-operative survival following bowel resection for Crohn's disease – a comparison of groups with and without residual disease at the margins.

Conclusions: In the surgical treatment of Crohn's, the benefits of close resection of macroscopically involved bowel may be offset by an increased risk of recurrence associated with residual microscopic disease at the anastamosis. The strong association shown here merits prospective evaluation.

1. Wolff BG (1983), The importance of disease-free margins in resections for Crohn's disease, Diseases of the Colon & Rectum, vol. 26 (4) pp. 239–43.

2. Kotanagi H (1991), Do microscopic abnormalities at resection margins correlate with increased anastomotic recurrence in Crohn's disease? Retrospective analysis of 100 cases, Diseases of the Colon & Rectum (1991), vol. 34 (10) pp. 909–16.