Abstract Background Intestinal resection is a therapeutic option for Crohn’s disease (CD), but postoperative recurrence remains a significant challenge.1 This study aimed to determine clinical and surgical recurrence within two years after intestinal resection and to identify associated factors. Methods This was an observational, retrospective, multicenter study involving adult patients with Crohn’s disease who underwent intestinal resection between 2014 and 2024.All patients were followed for a minimum of 24 months after surgery. Clinical recurrence was defined as the presence of symptoms confirmed by radiologic and/or endoscopic examinations, and surgical recurrence as the need for repeat resection. Both were considered early if they occurred within 12 months postoperatively. Results Seventy-six patients were included (mean age 31.7 ± 13.3 years; 51.3% female). Mean disease duration was 10.0 ± 9.1 years; 9.2% had surgery at diagnosis. Disease location was ileocolic 46.1%, ileal 44.7%, colonic 9.2%, mostly penetrating phenotype; 38% had perianal disease, and 22.4% were smokers. Most surgeries were elective (72.4%) with small bowel resection (mean 25.2 ± 19.4 cm). Postoperatively, 50% of untreated patients initiated therapy; 11.3% discontinued prior medication per risk assessment and patient preference. Clinical recurrence occurred in 30% (39.1% early), surgical recurrence in 11% (37.5% early); timing of recurrences after 12 months was not precisely determined. Patient, disease, therapy, and surgical factors were not significantly associated with recurrence. Histologic inflammation at the resection margins, despite macroscopically normal appearance, was associated with both clinical (p = 0.04; OR = 1.3; 95% CI, 1.0–14.7) and surgical recurrence (p = 0.03; OR = 1.8; 95% CI, 1.1–36.2) within two years. Granulomas in the resected specimen were associated with surgical recurrence in univariate analysis, but not in multivariate analysis. Conclusion Histologic inflammation at resection margins emerged as an independent risk factor for clinical and surgical recurrence within two years. Other established risk factors were not significant, likely reflecting tailored perioperative management. In line with previous studies2, these findings emphasize the prognostic importance of microscopic assessment of resection margins in Crohn’s disease and highlight the need for larger, robust studies to guide postoperative interventions based on histologic findings to prevent recurrence. References: 1. Bachour SP, Click BH. Clinical update on the prevention and management of postoperative Crohn’s disease recurrence. Curr Gastroenterol Rep. 2024;26(2):4152. doi:10.1007/s11894-023-00911-7. PMID:38227128. 2. Kelm M, Benatzky C, Buck V, Widder A, Schoettker K, Rosenfeldt M, Brand M, Schlegel N, Germer CT, Meining A, Nusrat A, Flemming S. Positive resection margins in Crohn’s disease are a relevant risk factor for postoperative disease recurrence. Sci Rep. 2024;14(1):10823. doi:10.1038/s41598-024-61697-w. PMID:38734721; PMCID:PMC11088694. Conflict of interest: Mrs. Teixeira, Madalena: No conflict of interest Lopes, Sara: No conflict of interest Tomás, David: No conflict of interest Bastos, António: No conflict of interest Simas, Diogo: No conflict of interest Caetano, Isabel: No conflict of interest Oliveira, Raquel: No conflict of interest to declare. Ferreira, Marisa: No conflict of interest Pestana, Madalena: No conflict of interest Teixeira, Cristina: No conflict of interest Freire, Ricardo: No conflict of interest
Teixeira et al. (Thu,) studied this question.