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

Aaltonen, Gisele; Ristimäki, Ari; Keränen, Ilona; Carpelan-Holmström, Monika; Lepistö, Anna

doi:10.1080/00365521.2018.1435717

Cited by 7 publications

(4 citation statements)

References 20 publications

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“…While the mean time from surgery to recurrence was comparable between both groups (4.5 versus 4.4 years), 75.5% of patients with a positive resection margin suffered from recurrence compared to 69.9% without microscopic inflammation (p = 0.57) [84]. Furthermore, in a single center study from Finland no significant differences were seen regarding the postoperative rates of disease recurrence in case of active inflammation at the resection margin [76]. Since the goal of CD surgery is usually a limited bowel resection to avoid short-bowl syndrome, extended resections are not supported based on the available evidence to date.…”

Section: Improved Surgical Technique May Further Support the Beneficial Effects Of Surgery To Maintain Remission In CDmentioning

confidence: 84%

“…Regarding anastomotic leakage, Garofalo et al reported that a positive proximal resection margin is associated with increased rates of anastomotic leakage postoperatively in comparison to patients without microscopic involvement of inflammatory cells of the anastomosis [74]. However, Schineis et al and Aaltonen et al reported in single center studies that no differences regarding anastomotic leakages were seen following microscopic inflammation, and that overall postoperative complications rates were low [75,76]. Similarly, analyzing our own cohort we did not see increased rates of anastomotic leakages for patients with positive resection margins following ileocecal resection (data not published yet).…”

Section: Improved Surgical Technique May Further Support the Beneficial Effects Of Surgery To Maintain Remission In CDmentioning

confidence: 99%

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

et al. 2021

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Crohn’s disease (CD) represents a heterogeneous and complex disease with no curative therapeutic option available to date. Current therapy is mainly antibody-based focusing on the immune system while other treatment alternatives such as surgery are considered to be “last options”. However, medical therapy for CD results in mild to severe side effects in a relevant amount of patients and some patients do not respond to the medication. Following that, quality of life is often significantly reduced in this patient cohort, thus, therapeutic alternatives are urgently needed. Updated evidence has revealed that surgery such as ileocecal resection (ICR) might be a potential therapeutic option in case of localized terminal ileitis since resection at early time points improves quality of life and significantly reduces the postoperative need for immunosuppressive medication with low rates of morbidity. In addition, new surgical approaches such as Kono-S anastomosis or inclusion of the mesentery result in significantly reduced rates of disease recurrence and reoperation. Based on the new evidence, the goal of this review is to provide an update on the role of surgery as a reasonable alternative to medical therapy in the interdisciplinary treatment of patients with CD.

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Section: Improved Surgical Technique May Further Support the Beneficial Effects Of Surgery To Maintain Remission In CDmentioning

confidence: 84%

Section: Improved Surgical Technique May Further Support the Beneficial Effects Of Surgery To Maintain Remission In CDmentioning

confidence: 99%

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

et al. 2021

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“…Furthermore, another relevant and well-discussed issue is the effect of the positive resection margins on the rates of postoperative disease recurrence [ 10 ]. The current evidence is heterogenous on the question of whether a positive resection margin results in a higher risk of disease recurrence [ 29 , 30 , 31 ]. While the current guidelines do not recommend inflammation-free margins due to the lack of robust evidence and the importance of bowel-sparing resections, future strategies could focus on the relevance of intraoperative diagnostics to avoid positive resection margins, as this is the state-of-the-art approach in surgical oncology.…”

Section: Discussionmentioning

confidence: 99%

Kono-S Anastomosis in Crohn’s Disease: A Retrospective Study on Postoperative Morbidity and Disease Recurrence in Comparison to the Conventional Side-To-Side Anastomosis

Kelm

Reibetanz

Kim³

et al. 2022

JCM

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Introduction: The rates of postoperative recurrence following ileocecal resection due to Crohn’s disease remain highly relevant. Despite this fact, while the Kono-S anastomosis technique initially demonstrated promising results, robust evidence is still lacking. This study aimed to analyze the short- and long-term outcomes of the Kono-S versus side-to-side anastomosis. Methods: A retrospective single-center study was performed including all patients who received an ileocecal resection between 1 January 2019 and 31 December 2021 at the Department of Surgery at the University Hospital of Wuerzburg. Patients who underwent conventional a side-to-side anastomosis were compared to those who received a Kono-S anastomosis. The short- and long-term outcomes were analyzed for all patients. Results: Here, 29 patients who underwent a conventional side-to-side anastomosis and 22 patients who underwent a Kono-S anastomosis were included. No differences were observed regarding short-term postoperative outcomes. The disease recurrence rate postoperatively was numerically lower following the Kono-S anastomosis (median Rutgeert score of 1.7 versus 2.5), with a relevantly increased rate of patients in remission (17.2% versus 31.8%); however, neither of these results reached statistical significance. Conclusion: The Kono-S anastomosis method is safe and feasible and potentially decreases the severity of postoperative disease remission.

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“…From 1945 citations, 23 studies (15 retrospective cohorts and 8 prospective cohorts) were included with a total of 7147 patients [32, 46–68]. Study and patient characteristics are presented in Table 1.…”

Section: Resultsmentioning

confidence: 99%

Using preoperative C‐reactive protein levels to predict anastomotic leaks and other complications after elective colorectal surgery: A systematic review and meta‐analysis

McKechnie,

Cloutier,

Archer

et al. 2024

Colorectal Disease

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AimWhile postoperative C‐reactive protein (CRP) is used routinely as an early indicator of anastomotic leak (AL), preoperative CRP remains to be established as a potential predictor of AL for elective colorectal surgery. The aim of this systematic review and meta‐analysis is to examine the association between preoperative CRP and postoperative complications including AL.MethodMEDLINE, EMBASE, Web of Science, PubMed, Cochrane Library and CINAHL databases were searched. Studies with reported preoperative CRP values and short‐term surgical outcomes after elective colorectal surgery were included. An inverse variance random effects meta‐analysis was performed for all meta‐analysed outcomes to determine if patients with or without complications and AL differed in their preoperative CRP levels. Risk of bias was assessed with MINORS and certainty of evidence with GRADE.ResultsFrom 1945 citations, 23 studies evaluating 7147 patients were included. Patients experiencing postoperative infective complications had significantly greater preoperative CRP values [eight studies, n = 2421 patients, mean difference (MD) 8.0, 95% CI 3.77–12.23, p < 0.01]. A significant interaction was observed with subgroup analysis based on whether patients were undergoing surgery for inflammatory bowel disease (X2 = 8.99, p < 0.01). Preoperative CRP values were not significantly different between patients experiencing and not experiencing AL (seven studies, n = 3317, MD 2.15, 95% CI −2.35 to 6.66, p = 0.35), nor were they different between patients experiencing and not experiencing overall postoperative morbidity (nine studies, n = 2958, MD 4.54, 95% CI −2.55 to 11.62, p = 0.31) after elective colorectal surgery.ConclusionHigher preoperative CRP levels are associated with increased rates of overall infective complications, but not with AL alone or with overall morbidity in patients undergoing elective colorectal surgery.

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

Cited by 7 publications

References 20 publications

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

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

Kono-S Anastomosis in Crohn’s Disease: A Retrospective Study on Postoperative Morbidity and Disease Recurrence in Comparison to the Conventional Side-To-Side Anastomosis

Using preoperative C‐reactive protein levels to predict anastomotic leaks and other complications after elective colorectal surgery: A systematic review and meta‐analysis

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