Abstract
The relationship between histologic changes at resection margins and anastomotic recurrence was evaluated in patients with Crohn's disease. Pathology and medical records from 1960 to 1977 identified 100 patients who met the following criteria: 1) no prior surgery for Crohn's disease, 2) small bowel or small bowel and colonic resection with anastomosis done for Crohn's disease at the Cleveland Clinic, and 3) resection margins available for microscopic analysis. The following histologic features of the margins were evaluated: edema, inflammation, lymphoid aggregates, pyloric metaplasia, fibrosis, cryptitis and crypt abscesses, ulcers, granulomas, villous shortening, mucin depletion, neuronal hyperplasia, and transmural inflammation. Additionally, margins were categorized as histologically normal, showing nonspecific changes, showing changes suggestive of Crohn's disease, and showing changes diagnostic for Crohn's disease. Anastomotic recurrence occurred in 50 patients after an average follow-up period of 11.5 years. Cumulative recurrence-free rates for the four margin categories were not significantly different. Anastomotic recurrence was not associated with any clinical or histologic feature or combination of features.
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Bergman L, Krause U. Crohn's disease: a long-term study of the clinical course in 186 patients. Scand J Gastroenterol 1977;12:937–44.
Ihasz M, Mester E, Refi M. Experience in surgical management of Crohn's disease. Am J Proctol 1975;26:47–62.
Nygaard K, Fausa O. Crohn's disease: recurrence after surgical treatment. Scand J Gastroenterol 1977;12:577–84.
Edwards H. Crohn's disease. J R Coll Surg Edinb 1964;9:115–27.
Colcock BP. Operative technique in surgery for Crohn's disease and its relationship to recurrence. Surg Clin North Am 1973;53:375–80.
Karesen R, Serch-Hanssen A, Thoresen BO, Hertzberg J. Crohn's disease: long-term results of surgical treatment. Scand J Gastroenterol 1981;16:57–64.
Wolff BG, Beart RW Jr, Frydenberg HB, Weiland LH, Agrez MV, Ilstrup DM. The importance of diseasefree margins in resection for Crohn's disease. Dis Colon Rectum 1983;26:239–43.
Hamilton SR, Reese J, Pennington L, Boitnott JK, Bayless TM, Cameron JL. The role of resection margin frozen section in the surgical management of Crohn's disease. Surg Gynecol Obstet 1985;160:57–62.
Pennington L, Hamilton SR, Bayless TM, Cameron JL. Surgical management of Crohn's disease: influence of disease at margin of resection. Ann Surg 1980;192:311–8.
Papaioannou N, Piris J, Lee ECG, Kettlewell MG. The relationship between histologic inflammation in the cut end after resection of Crohn's disease and recurrence. Gut 1979;20:A916.
Heuman R, Boeryd B, Bolin T, Sjodahi R. The influence of disease at the margin of resection on the outcome of Crohn's disease. Br J Surg 1983;70:519–21.
Cooper JC, Williams NS. The influence of microscopic disease at the margin of resection on the recurrence rates in Crohn's disease. Ann R Coll Surg Engl 1986;68:23–6.
Chardavoyne R, Flint GW, Pollack S, Wise L. Factors affecting recurrence following resection for Crohn's disease. Dis Colon Rectum 1986;29:495–502.
Adloff M, Arnaud J, Ollier J. Does the histologic appearance at the margin of resection affect the postoperative recurrence rate in Crohn's disease? Am Surg 1987;53:543–6.
Rutgeerts P, Geboes K, Vantrappen G, Kerremans R, Coenegrachts JL, Coremans G. Natural history of recurrent Crohn's disease at the ileocolonic anastomosis after curative surgery. Gut 1984;25:666–72.
Lennard-Jones JE, Stalder GA. Prognosis after resection of chronic regional ileitis. Gut 1967;8:332–6.
de Dombal FT, Burton I, Goligher JC. Recurrence of Crohn's disease aftr primary excisional surgery. Gut 1971;12;519–27.
Alexander-Williams J. Progress report: the place of surgery in Crohn's disease. Gut 1971;12:739–49.
Colcock BP, Vansant JH. Surgical treatment of regional enteritis. N Engl J Med 1960;262:436–9.
Fielding JF, Cooke WT, Alexander-Williams J. The incidence of recurrence of Crohn's disease. Surg Gynecol Obstet 1972;134:467–9.
Frikker MJ, Segall MM. The resectional reoperation rate for Crohn's disease in a general community hospital. Dis Colon Rectum 1983;26:305–9.
Greenstein AJ, Sachar DB, Pasternack BS, Janowitz HD. Reoperation and recurrence in Crohn's colitis and ileocolitis: crude and cumulative rates. N Engl J Med 1975;293:685–90.
Hellers G. Crohn's disease in Stockholm County 1955–1974. Acta Chir Scand 1979;490(Suppl):1–4.
Lock MR, Farmer RG, Fazio VW, Jagelman DG, Lavery IC, Weakley FL. Recurrence and reoperation for Crohn's disease: the role of disease location in prognosis. N Engl J Med 1981;304:1586–8.
Lock MR, Fazio VW, Farmer RG, Jagelman DG, Lavery IC, Weakley FL. Proximal recurrence and the fate of the rectum following excisional surgery for Crohn's disease of the large bowel. Ann Surg 1981;194:754–60.
Mekhjiam HS, Switz DM, Watts D, Deren JJ, Katon RM, Beman FM. National cooperative Crohn's disease study: factors determining recurrence of Crohn's disease after surgery. Gastroenterology 1979;77:907–13.
Trnka YM, Glotzer DJ, Kasdon EJ, Goldman H, Steer ML, Goldman LO. The long-term outcome of restorative operation in Crohn's disease. Ann Surg 1982;196:345–55.
Whelan G, Farmer RG, Fazio VW, Goormastic M. Recurrence after surgery in Crohn's disease: relationship to location of disease (clinical pattern) and surgical indication. Gastroenterology 1985;88:1826–33.
Cooke WT, Mallas E, Prior P, Allan RN. Crohn's disease: course, treatment, and long-term prognosis. Q J Med 1980;49:363–84.
Kyle J. Prognosis after ileal resection for Crohn's disease. Br J Surg 1971;58:735–7.
Softley A, Myren J, Clamp SE, Bouchier IAD, Watkinson G, de Dombal FT. Factors affecting recurrence after surgery for Crohn's disease. Scand J Gastroenterol 1988;23(Suppl):31–34.
Ellis L, Calhoun P, Kaiser DL, Rudolf LE, Hanks JB. Postoperative recurrence in Crohn's disease: the effect of the initial length of bowel resection and operative procedure. Ann Surg 1984;199:340–7.
Hellborg R, Hulten L, Rosengren C, Ahren C. The recurrence rate after primary excisional surgery for Crohn's disease. Acta Chir Scand 1980;146:435–43.
Higgens CS, Allan RN. Crohn's disease of the distal ileum. Gut 1980;21:933–40.
Truelove SC, Pena AS. Course and prognosis of Crohn's disease. Gut 1976;17:192–201.
Atwell JD, Duthie HL, Goligher JC. The outcome of Crohn's disease. Br J Surg 1965;52:966–72.
Stahlgren LH, Ferguson LK. The results of surgical treatment of chronic regional enteritis. JAMA 1961;175:986–9.
Sachar DB, Wolfson DM, Greenstein AJ, Goldberg J, Styczynski R, Janowitz HD. Risk factors for postoperative recurrence of Crohn's disease. Gastroenterology 1983;85:917–21.
Wolfson DM, Sachar DB, Cohen A,et al. Do granulomas affect postoperative recurrence rate in Crohn's disease? Gastroenterology 1981;80:1319.
Fawaz KA, Glotzer DJ, Goldman H, Dickersin GR, Gross W, Patterson JF. Ulcerative colitis and Crohn's disease of the colon—a comparison of the long-term postoperative courses. Gastroenterology 1976;71:372–8.
Homan WP, Gray GF Jr, Dineen P. Granulomas in Crohn's disease. Lancet 1978;2:112.
Lindhagen T, Ekelund G, Leandoer L, Hildell J, Lindstrom C, Wenckert A. Recurrence rate after sur-4 gical treatment of Crohn's disease. Scand J Gastroenterol 1983;18:1037–44.
Wolfson DM, Sachar DB, Cohen A,et al. Granulomas do not affect postoperative recurrence rates in Crohn's disease. Gastroenterology 1982;83:405–9.
Speranza V, Simi M, Leardi S, Del Papa M. Recurrence of Crohn's disease after resection. J Clin Gastroenterol 1986;8:640–6.
Van Patter EN, Bargen JA, Dockerty MB, Feldman WH, Mayo CW, Waugh JM. Regional enteritis. Gastroenterology 1954;26:347–450.
Lee EC, Papaioannou N. Recurrence following surgery for Crohn's disease. Baillieres Clin Gastroenterol 1980;9:419–38.
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Kotanagi, H., Kramer, K., Fazio, V.W. et al. Do microscopic abnormalities at resection margins correlate with increased anastomotic recurrence in Crohn's disease?. Dis Colon Rectum 34, 909–916 (1991). https://doi.org/10.1007/BF02049707
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DOI: https://doi.org/10.1007/BF02049707