Does a histologically inflamed resection margin increase postoperative complications in patients with Crohn’s disease?

Abstract

Objectives: Our study assessed whether the presence of histologically inflamed resection margins increased postoperative anastomotic complications in Crohn’s disease (CD) patients. We also examined the influence of other risk factors for postoperative complications.

Materials and methods: Presence of chronic inflammation and activity of inflammation was scored from the resection margin specimens of 70 patients undergoing surgery due to CD. Anastomotic complications were recorded with a one-month follow-up. We also analysed other risk factors for postoperative complications, such as patient age, previous surgeries, preoperative C-reactive protein, faecal calprotectin, albumin and haemoglobin levels, American Society of Anesthesiologists (ASA) classification, preoperative immunosuppressive medication, surgical approach and the presence of intraoperative fistula or abscess.

Results: In total, 46 patients (65.7%) had active inflammation in the bowel resection margin – 12 patients (17.1%) with mild, five patients (7.1%) with moderate and 29 patients (41.4%) with strong activity. We found 14 (20.0%) postoperative complications, of which three (4.6%) were anastomotic. The presence of active inflammation at the resection margin did not significantly influence the occurrence of postoperative anastomotic complications. None of the other risk factors examined significantly increased postoperative complications among our sample.

Conclusions: After bowel-sparing surgery for CD, the frequency of histologically inflamed resection margins is high. However, postoperative complication rate remains low. The current practice with resection of only the most affected bowel segments for CD seems to be a safe choice. We still need further research concerning risk factors for postoperative complications in Crohn’s patients.

Keywords:

• Crohn’s disease
• surgery
• resection margin
• histological inflammation
• postoperative complications
• inflammatory bowel disease

Acknowledgements

Compliance with ethical standards: All procedures performed in this study were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration comparable ethical standards. For this type of study, formal consent is not required.

Disclosure statement

The authors report no conflicts of interest.