Effect of resection margins on the recurrence of Crohn's disease in the small bowel

A randomized controlled trial

Victor W. Fazio, Floriano Marchetti, James M. Church, John R. Goldblum, Lan C. Lavery, Tracy L. Hull, Jeffrey W. Milsom, Scott A. Strong, John R. Oakley, Michelle Secic

Research output: Contribution to journalArticle

264 Citations (Scopus)

Abstract

Objective: The authors assess the effect of surgical margin width on recurrence rates after intestinal resection for Crohn's Disease (CD). Background: The optimal width of margins when resecting CD of the small bowel is controversial. Most studies have been retrospective and have had conflicting results. Methods: Patients undergoing ileocolic resection for CD (N = 152) were randomly assigned to two groups in which the proximal line of resection was 2 cm (limited resection) or 12 cm (extended resection) from the macroscopically involved area. Patients also were classified by whether the margin of resection was microscopically normal (category 1), contained nonspecific changes (category 2), were suggestive but not diagnostic for CD (category 3), or were diagnostic for CD (category 4). Recurrence was defined as reoperation for recurrent preanastomotic disease. Results: Data were collected on 131 patients. Median follow up time was 55.7 months. Disease recurred in 29 patients: 25% of patients in the limited resection group and 18% of patients in the extended resection group. In the 90 patients in category 1 with normal tissue, recurrence occurred in 16, whereas in the 41 patients with some degree of microscopic involvement, recurrence occurred in 13. Recurrence rates were 36% in category 2, 39% in category 3, and 21% in category 4. No group differences were statistically significant at the 0.01 level. Conclusion: Recurrence of CD is unaffected by the width of the margin of resection from macroscopically involved bowel. Recurrence rates also do not increase when microscopic CD is present at the resection margins. Therefore, extensive resection margins are unnecessary.

Original languageEnglish
Pages (from-to)563-573
Number of pages11
JournalAnnals of Surgery
Volume224
Issue number4
DOIs
StatePublished - Oct 19 1996
Externally publishedYes

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Crohn Disease
Randomized Controlled Trials
Recurrence
Margins of Excision
Reoperation

ASJC Scopus subject areas

  • Surgery

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Effect of resection margins on the recurrence of Crohn's disease in the small bowel : A randomized controlled trial. / Fazio, Victor W.; Marchetti, Floriano; Church, James M.; Goldblum, John R.; Lavery, Lan C.; Hull, Tracy L.; Milsom, Jeffrey W.; Strong, Scott A.; Oakley, John R.; Secic, Michelle.

In: Annals of Surgery, Vol. 224, No. 4, 19.10.1996, p. 563-573.

Research output: Contribution to journalArticle

Fazio, VW, Marchetti, F, Church, JM, Goldblum, JR, Lavery, LC, Hull, TL, Milsom, JW, Strong, SA, Oakley, JR & Secic, M 1996, 'Effect of resection margins on the recurrence of Crohn's disease in the small bowel: A randomized controlled trial', Annals of Surgery, vol. 224, no. 4, pp. 563-573. https://doi.org/10.1097/00000658-199610000-00014
Fazio, Victor W. ; Marchetti, Floriano ; Church, James M. ; Goldblum, John R. ; Lavery, Lan C. ; Hull, Tracy L. ; Milsom, Jeffrey W. ; Strong, Scott A. ; Oakley, John R. ; Secic, Michelle. / Effect of resection margins on the recurrence of Crohn's disease in the small bowel : A randomized controlled trial. In: Annals of Surgery. 1996 ; Vol. 224, No. 4. pp. 563-573.
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abstract = "Objective: The authors assess the effect of surgical margin width on recurrence rates after intestinal resection for Crohn's Disease (CD). Background: The optimal width of margins when resecting CD of the small bowel is controversial. Most studies have been retrospective and have had conflicting results. Methods: Patients undergoing ileocolic resection for CD (N = 152) were randomly assigned to two groups in which the proximal line of resection was 2 cm (limited resection) or 12 cm (extended resection) from the macroscopically involved area. Patients also were classified by whether the margin of resection was microscopically normal (category 1), contained nonspecific changes (category 2), were suggestive but not diagnostic for CD (category 3), or were diagnostic for CD (category 4). Recurrence was defined as reoperation for recurrent preanastomotic disease. Results: Data were collected on 131 patients. Median follow up time was 55.7 months. Disease recurred in 29 patients: 25{\%} of patients in the limited resection group and 18{\%} of patients in the extended resection group. In the 90 patients in category 1 with normal tissue, recurrence occurred in 16, whereas in the 41 patients with some degree of microscopic involvement, recurrence occurred in 13. Recurrence rates were 36{\%} in category 2, 39{\%} in category 3, and 21{\%} in category 4. No group differences were statistically significant at the 0.01 level. Conclusion: Recurrence of CD is unaffected by the width of the margin of resection from macroscopically involved bowel. Recurrence rates also do not increase when microscopic CD is present at the resection margins. Therefore, extensive resection margins are unnecessary.",
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AU - Church, James M.

AU - Goldblum, John R.

AU - Lavery, Lan C.

AU - Hull, Tracy L.

AU - Milsom, Jeffrey W.

AU - Strong, Scott A.

AU - Oakley, John R.

AU - Secic, Michelle

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N2 - Objective: The authors assess the effect of surgical margin width on recurrence rates after intestinal resection for Crohn's Disease (CD). Background: The optimal width of margins when resecting CD of the small bowel is controversial. Most studies have been retrospective and have had conflicting results. Methods: Patients undergoing ileocolic resection for CD (N = 152) were randomly assigned to two groups in which the proximal line of resection was 2 cm (limited resection) or 12 cm (extended resection) from the macroscopically involved area. Patients also were classified by whether the margin of resection was microscopically normal (category 1), contained nonspecific changes (category 2), were suggestive but not diagnostic for CD (category 3), or were diagnostic for CD (category 4). Recurrence was defined as reoperation for recurrent preanastomotic disease. Results: Data were collected on 131 patients. Median follow up time was 55.7 months. Disease recurred in 29 patients: 25% of patients in the limited resection group and 18% of patients in the extended resection group. In the 90 patients in category 1 with normal tissue, recurrence occurred in 16, whereas in the 41 patients with some degree of microscopic involvement, recurrence occurred in 13. Recurrence rates were 36% in category 2, 39% in category 3, and 21% in category 4. No group differences were statistically significant at the 0.01 level. Conclusion: Recurrence of CD is unaffected by the width of the margin of resection from macroscopically involved bowel. Recurrence rates also do not increase when microscopic CD is present at the resection margins. Therefore, extensive resection margins are unnecessary.

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