Sant'Andrea Hospital, Rome, Italy.
Colorectal Unit, Queen Alexandra Hospital-Portsmouth Hospitals NHS Trust, Portsmouth, UK.
Int J Colorectal Dis. 2019 Sep;34(9):1585-1590. doi: 10.1007/s00384-019-03358-3. Epub 2019 Aug 3.
Bowel resection in patients with Crohn's disease (CD) has a high reported rate of postoperative complications and surgical recurrence. A macroscopically normal resection margin is recommended in CD surgery as wider margins do not translate in reduced recurrence rates. The aim of this study was to evaluate the association between resection margin status and anastomotic complications following ileocaecal resection for primary CD.
All patients treated with ileocaecal resection for primary CD from 2010 to 2018 were included in this retrospective observational study. Emergency operations and recurrent CD were excluded. Patients in whom an anastomosis was not fashioned at the time of the surgery were also excluded. Histopathology data collected included macroscopic description, presence of macroscopic and microscopic involvement of the proximal and distal resection margins. The primary outcome was the rate of positive resection margin in patients who developed anastomotic complications (anastomotic leaks and intra-abdominal collections), and the secondary outcomes were overall complications rate, length of hospital stay, reoperations and rehospitalisation within 30 days.
A total of 104 patients were included. The proximal resection margin was microscopically involved in 19 patients (18.2%). Ten patients (9.6%) developed intra-abdominal anastomotic related complications, with 5 patients out of 10 (50%) in the group of postoperative anastomotic complications having a positive microscopic proximal margin at histology, compared to 14 patients (14.9%) in the group that did not develop anastomotic complications (p < 0.0001).
Microscopic involvement of the proximal resection margin is more frequent in patients who develop postoperative anastomotic complications following elective ileocaecal resection for primary CD.
克罗恩病（CD）患者的肠切除术术后并发症和手术复发率报告较高。CD 手术中推荐采用宏观正常的切缘，因为更宽的切缘并不能降低复发率。本研究旨在评估原发性 CD 回肠末端切除术吻合口并发症与切缘状态之间的关系。
本回顾性观察性研究纳入了 2010 年至 2018 年期间因原发性 CD 接受回肠末端切除术治疗的所有患者。排除急诊手术和复发性 CD 患者。未在手术时进行吻合术的患者也被排除在外。收集的组织病理学数据包括宏观描述、近端和远端切缘的宏观和微观受累情况。主要结局是发生吻合口并发症（吻合口漏和腹腔内积液）的患者中阳性切缘的发生率，次要结局是总体并发症发生率、住院时间、再次手术和 30 天内再次住院。
共纳入 104 例患者。19 例（18.2%）患者近端切缘镜下受累。10 例（9.6%）患者发生腹腔内吻合口相关并发症，其中 5 例（50%）术后吻合口并发症组患者组织学检查近端镜下切缘阳性，而未发生吻合口并发症组患者 14 例（14.9%）（p<0.0001）。
在因原发性 CD 行择期回肠末端切除术的患者中，发生术后吻合口并发症的患者近端切缘镜下受累更为常见。
