Ileocecal Resections for Crohn’s: Predictive Value of Resection Margins on the Risk of Re-Surgery in the Swiss IBD Cohort

Author(s): Emilie Zhu, Raphaël Hadorn, Valerie EH Pittet, Alain Schoepfer, SIBDCS group, Dieter Hahnloser

Background: Whether positive resection margins have an influence on surgical recurrence is still a matter of debate for Crohn’s disease (CD) patients undergoing ileocecal resection. The aims of this study were to analyze whether the involvement of the resection margins had a negative impact on endoscopic or surgical recurrence after ileocecal resection for CD diseases in a national Swiss cohort.

Methods: Retrospective analysis of the prospective Swiss Inflammatory Bowel Disease Cohort Study (SIBDCS) database of patients with ileocecal resection in whom pathology reports could be retrieved (n=82). The primary outcome was surgical recurrence.

Results: The median follow-up was 8 years. Pathology reports were not standardized, did not mention the resection margins in 13%, and often did not include important features such as myenteric and submucosal plexitis. Positive small bowel margins were significantly associated with surgical recurrence (p=0.022) but not with endoscopic recurrence.

Conclusion: Positive small bowel margins are associated with surgical recurrence. Pathology reports in Switzerland are still lacking important information and should be standardized in order to stratify the postoperative risk of recurrence.