THE ROLE OF RESECTION MARGIN FROZEN SECTION IN THE SURGICAL-MANAGEMENT OF CROHNS-DISEASE

  • 1 January 1985
    • journal article
    • research article
    • Vol. 160  (1) , 57-62
Abstract
The use of frozen section examination of resection margins in selecting the site for an ileocolonic anastomosis was evaluated in patients with Crohn''s disease. Patients (79) with ileitis or ileocolitis who underwent 1st resection with removal of all apparent disease and primary ileocolonic anastomosis were studied. The patients with a resection margin examined by frozen section (FS group, n = 38) and those with margins chosen on the basis of visual inspection alone (NO-FS group, n = 41) were compared. Frozen section examination was found to be poor at detecting margin involvement: although 60 of 61 margins examined by frozen section were reported as negative at the time of operation, 20 of 61 were actually involved by Crohn''s disease. Despite the use of frozen section examination, the prevalence and severity of margin involvement in the FS and NO-FS groups were not statistically significantly different. Short-term and long-term clinical outcome were also not statistically different; the incidence of postoperative anastomotic leakage and obstruction was 13% in the FS group and 5% in the NO-FS groups (P NS [not significant]). Clinical recrudescence rates by life table analysis in the FS and NO-FS groups were 37 .+-. 9% and 50 .+-. 8%, respectively, at 5 yr and 60 .+-. 12% and 66 .+-. 9% at 10 yr (P NS). Reoperation rates were 18 .+-. 8% at 5 yr in both groups and 36 .+-. 13% in the FS group and 32 .+-. 12% in the NO-FS group at 10 yr. The findings support conservative resection to achieve grossly uninvolved margins rather than sacrifice of functional intestine in an attempt to achieve histopathologically uninvolved margins on frozen section.

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