EFFECT OF RESECTION MARGINS ON THE RECURRENCE OF CROHNS-DISEASE IN THE SMALL-BOWEL - A RANDOMIZED CONTROLLED TRIAL

Objective The authors assess the effect of surgical margin width on re currence rates after intestinal resection for Crohn's Disease (CD). Ba ckground The optimal width of margins when resecting CD of the small b owel is controversial. Most studies have been retrospective and have h ad conflicting results. Methods Patients undergoing ileocolic resectio n for CD (N = 152) were randomly assigned to two groups in which the p roximal line of resection was 2 cm (limited resection) or 12 cm (exten ded resection) from the macroscopically involved area. Patients also w ere 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 recurre nt preanastomotic disease. Results Data were collected on 131 patients . Median follow-up time was 55.7 months. Disease recurred in 29 patien ts: 25% of patients in the limited resection group and 18% of patients in the extended resection group. In the 90 patients in category 1 wit h normal tissue, recurrence occurred in 16, whereas in the 41 patients with some degree of microscopic involvement, recurrence occurred in 1 3. 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 widt h of the margin of resection from macroscopically involved bowel. Recu rrence rates also do not increase when microscopic CD is present at th e resection margins. Therefore, extensive resection margins are unnece ssary.