P1051 The role of Resection Margins in Crohn`s Disease – A potential risk factor for Disease Recurrence?

Abstract

Abstract Background Postoperative disease recurrence after ileocecal resection for Crohn`s Disease is a major issue for all disciplines. While adequate therapeutic strategies are lacking, further criteria are necessary to improve the identification of patients at risk for disease recurrence. In line with that, the exact role of positive resection margins as a potential risk factor on disease recurrence remains unclear since current evidence is heterogenous. Methods All patients who received ileocecal resection due to localized terminal ileitis Crohn at the Department of Surgery at the University Hospital of Wuerzburg between 2014 and 2021 were evaluated. Primary endpoints were severe endoscopic (Rutgeerts-Score >2) and surgical recurrence (re-operation due to Crohn`s Disease) during follow up. Positive resection margins were identified by two independent pathologists and defined by the following criteria as international consensus: neutrophils localized in the epithelium, cryptitis, and/or plexitis. Results 214 patients received ileocecal resection at the Department of Surgery. Of those, 159 patients were finally included for analysis with a median follow up of 35 months. Postoperative morbidity was not affected by inflammation at the resection margins. However, positive resection margins resulted in significantly increased rates of severe endoscopic recurrence at six months (2.0% versus 15.6%, p=0.02) and overall (4.2% versus 19.6%, p=0.001). Additionally, positive margins resulted in significantly increased rates of surgical recurrence (0% versus 4.5%, p=0.04). Conclusion Positive resection margins in Crohn`s Disease are associated with increased rates of severe endoscopic and surgical recurrence and should therefore be considered as risk factor for postoperative disease recurrence.