Stéphanie Decousus1, Anne-Laure Boucher2, Juliette Joubert1, Bruno Pereira3, Anne Dubois4, Felix Goutorbe2, Pierre J Déchelotte1, Gilles Bommelaer5, Anthony Buisson6. 1. Pathology Department, University Hospital Estaing, Clermont-Ferrand, France. 2. Gastroenterology Department, University Hospital Estaing, Clermont-Ferrand, France. 3. DRCI, Biostatistics Unit, GM Clermont-Ferrand University and Medical Center, Clermont-Ferrand, France. 4. Digestive Surgery Department, University Hospital Estaing, Clermont-Ferrand, France. 5. Gastroenterology Department, University Hospital Estaing, Clermont-Ferrand, France; Microbes, Intestine, Inflammation and Susceptibility of the Host, UMR 1071 Inserm/Université d'Auvergne, USC-INRA 2018, Clermont-Ferrand, France. 6. Gastroenterology Department, University Hospital Estaing, Clermont-Ferrand, France; Microbes, Intestine, Inflammation and Susceptibility of the Host, UMR 1071 Inserm/Université d'Auvergne, USC-INRA 2018, Clermont-Ferrand, France. Electronic address: a_buisson@hotmail.fr.
Abstract
BACKGROUND: As surgical resection is not curative in Crohn's disease, postoperative recurrence remains a crucial issue. The selection of patients, according to available risk factors, remains disappointing in clinical practice highlighting the need for better criteria, such as histologic features. AIMS: To investigate whether submucosal and myenteric plexitis increase the risk of endoscopic, clinical and surgical postoperative recurrence in Crohn's disease. METHODS: From the pathology department database, we retrospectively retrieved the data of all the patients who have undergone ileocolonic resection for Crohn's disease. Two pathologists, blinded from clinical data, reviewed all specimens to evaluate the presence of plexitis at the proximal resection margin. RESULTS: Of the 75 included CD patients, 19 (25.3%) had histological involvement of resection margin. Inflammatory cells count for myenteric and submucosal plexus were performed in 56 patients. In multivariate analysis, the myenteric plexitis was a risk factor for endoscopic postoperative recurrence (HR 8.83 CI95% [1.6-48.6], p=0.012), and the presence of at least one myenteric lymphocyte (HR 4.02 CI95% [1.4-11.2], p=0.008) was predictive of clinical postoperative recurrence. We observed no histologic predictor for surgical postoperative recurrence. CONCLUSION: Myenteric plexitis in proximal margins of ileocolonic resection specimens is independently associated with endoscopic and clinical postoperative recurrence in Crohn's disease.
BACKGROUND: As surgical resection is not curative in Crohn's disease, postoperative recurrence remains a crucial issue. The selection of patients, according to available risk factors, remains disappointing in clinical practice highlighting the need for better criteria, such as histologic features. AIMS: To investigate whether submucosal and myenteric plexitis increase the risk of endoscopic, clinical and surgical postoperative recurrence in Crohn's disease. METHODS: From the pathology department database, we retrospectively retrieved the data of all the patients who have undergone ileocolonic resection for Crohn's disease. Two pathologists, blinded from clinical data, reviewed all specimens to evaluate the presence of plexitis at the proximal resection margin. RESULTS: Of the 75 included CDpatients, 19 (25.3%) had histological involvement of resection margin. Inflammatory cells count for myenteric and submucosal plexus were performed in 56 patients. In multivariate analysis, the myenteric plexitis was a risk factor for endoscopic postoperative recurrence (HR 8.83 CI95% [1.6-48.6], p=0.012), and the presence of at least one myenteric lymphocyte (HR 4.02 CI95% [1.4-11.2], p=0.008) was predictive of clinical postoperative recurrence. We observed no histologic predictor for surgical postoperative recurrence. CONCLUSION:Myenteric plexitis in proximal margins of ileocolonic resection specimens is independently associated with endoscopic and clinical postoperative recurrence in Crohn's disease.
Authors: G Pellino; D S Keller; G M Sampietro; I Angriman; M Carvello; V Celentano; F Colombo; F Di Candido; S Laureti; G Luglio; G Poggioli; M Rottoli; S Scaringi; G Sciaudone; G Sica; L Sofo; S Leone; S Danese; A Spinelli; G Delaini; F Selvaggi Journal: Tech Coloproctol Date: 2020-03-14 Impact factor: 3.781