Positive Histological Inflammatory Margins Are Associated With Increased Risk for Intra-abdominal Septic Complications in Patients Undergoing Ileocolic Resection for Crohn's Disease

ArticleinDiseases of the Colon & Rectum 55(11):1125-30 · November 2012with76 Reads
DOI: 10.1097/DCR.0b013e318267c74c · Source: PubMed
Abstract
: Rates of postoperative complications are particularly high among patients with Crohn's disease. : The aim of this study was to assess whether positive inflammatory histological margins, among other factors, pose a risk for intra-abdominal septic complications in patients with Crohn's disease undergoing ileocolic resection. : A retrospective study of patient records, during 2000-2010, was conducted. : This investigation was performed at a single medical center. : Included were 166 individuals with Crohn's disease (85 males, mean age 35.6). : Ileocolic resection with primary anastomosis was performed. : The primary outcomes measured were postoperative intra-abdominal septic complications. : Twenty-five patients (15%) developed intra-abdominal septic complications, including anastomotic leak, intra-abdominal abscesses and collections, and enterocutaneous fistulas. There were no postoperative deaths. Univariate analysis revealed that a long course of disease before surgery, an emergency surgery, steroid treatment of more than 3 months before surgery, additional sigmoidectomy, and positive surgical margins detected on histopathological examination were associated with intra-abdominal septic complications. In a multivariate analysis, only disease duration longer than 10 years (OR 4.575 (CI 1.592-13.142), p = 0.005), additional sigmoidectomy (OR 5.768 (CI 1.088-30.568), p = 0.04), and positive histological resection margins (OR 2.996 (CI 1.085-8.277), p = 0.03) were found to be independent risk factors. : This study was limited by the incomplete data regarding preoperative albumin levels. : Positive histological margins, disease duration of more than 10 years, and added sigmoidectomy are independent risk factors that are associated with postoperative intra-abdominal septic complications in patients undergoing ileocolic resection for Crohn's disease. These risk factors should be considered when the need for a diverting stoma is questionable. A frozen section of the margins may assist in the decision as to a temporary ileostomy construction.
    • "Our predefined search strategy identified a total of 813 studies; 778 of these studies did not meet the inclusion criteria and were excluded from further analysis. The remaining 35 studies were retrieved for full text articles 3,4,5,6,7,8,9,12,13,14,15,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,39,40,41,42,43,44 ; a related articles search and an examination of the bibliography of these references identified three studies of possible interest. 10,45,46 In total, 38 studies were acquired for further analysis. "
    [Show abstract] [Hide abstract] ABSTRACT: Background and Aims Postoperative intra-abdominal septic complications (IASCs) are the most feared risks of surgery for Crohn's disease(CD). The risk factors for IASCs still remain controversial. The aim of this study was to assess the risk factors for IASCs in CD patients undergoing abdominal surgery. Methods MEDLINE, Cochrane Library, EMBASE were searched to identify observational studies reporting the risk factors for IASCs in CD patients. A meta-analysis was conducted to investigate the impact of various risk factors on IASCs in CD. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach was used for quality assessment of evidence on outcome levels. Results This review included 15 studies evaluating 3807 patients undergoing 4189 operations. The meta-analyses found that low albumin levels (OR: 1.93; 95% CI: 1.36- 2.75), preoperative steroids use (OR: 1.99; 95% CI: 1.54-2.57), a preoperative abscess (OR: 1.94; 95% CI: 1.26- 3.0), previous surgery history (OR: 1.50; 95% CI: 1.15- 1.97) may be risk factors for IASCs. There were no associations between anastomosis methods (OR: 0.94; 95% CI: 0.58-1.53), biologics therapy (OR: 1.29; 95% CI: 0.79- 2.11) and immunomodulator use (OR: 1.07; 95% CI: 0.66- 1.73) with the risk of IASCs. Due to observational design, the quality of evidence was regarded low or moderate for these risk factors by the GRADE approach. Conclusions This meta-analysis provides some evidence that steroids use, previous surgery history, a preoperative abscess and low albumin levels may be associated with higher rates of IASCs in CD. Knowledge about those risk factors may influence treatment and procedure related decisions, and possibly reduce the IASCs rate. Copyright © 2015 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.
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