Published online Jul 27, 2017. doi: 10.4240/wjgs.v9.i7.167
Peer-review started: February 6, 2017
First decision: March 13, 2017
Revised: April 25, 2017
Accepted: May 22, 2017
Article in press: May 24, 2017
Published online: July 27, 2017
To evaluate the presence of submucosal and myenteric plexitis and its role in predicting postoperative recurrence.
Data from all patients who underwent Crohn’s disease (CD)-related resection at the University of Szeged, Hungary between 2004 and 2014 were analyzed retrospectively. Demographic data, smoking habits, previous resection, treatment before and after surgery, resection margins, neural fiber hyperplasia, submucosal and myenteric plexitis were evaluated as possible predictors of postoperative recurrence. Histological samples were analyzed blinded to the postoperative outcome and the clinical history of the patient. Plexitis was evaluated based on the appearance of the most severely inflamed ganglion or nerve bundle. Patients underwent regular follow-up with colonoscopy after surgery. Postoperative recurrence was defined on the basis of endoscopic and clinical findings, and/or the need for additional surgical resection.
One hundred and four patients were enrolled in the study. Ileocecal, colonic, and small bowel resection were performed in 73.1%, 22.1% and 4.8% of the cases, respectively. Mean disease duration at the time of surgery was 6.25 years. Twenty-six patients underwent previous CD-related surgery. Forty-three point two percent of the patients were on 5-aminosalicylate, 20% on corticosteroid, 68.3% on immunomodulant, and 4% on anti-tumor necrosis factor-alpha postoperative treatment. Postoperative recurrence occurred in 61.5% of the patients; of them 39.1% had surgical recurrence. 92.2% of the recurrences developed within the first five years after the index surgery. Mean disease duration for endoscopic relapse was 2.19 years. The severity of submucosal plexitis was a predictor of the need for second surgery (OR = 1.267, 95%CI: 1.000-1.606, P = 0.050). Female gender (OR = 2.21, 95%CI: 0.98-5.00, P = 0.056), stricturing disease behavior (OR = 3.584, 95%CI: 1.344-9.559, P = 0.011), and isolated ileal localization (OR = 2.671, 95%CI: 1.033-6.910, P = 0.043) were also predictors of postoperative recurrence. No association was revealed between postoperative recurrence and smoking status, postoperative prophylactic treatment and the presence of myenteric plexitis and relapse.
The presence of severe submucosal plexitis with lymphocytes in the proximal resection margin is more likely to result in postoperative relapse in CD.
Core tip: This is a retrospective study to evaluate the presence of submucosal and myenteric plexitis and its role in predicting postoperative recurrence (POR) in Crohn’s disease. Demographic data, smoking habits, previous resection, treatment before and after surgery, and histological findings were evaluated as possible predictors of POR. We found that the severity of submucosal plexitis was a predictor of the need for second surgery. Other predictors of POR were female gender, stricturing disease behavior, and isolated ileal localization. Our results did not confirm the hypothesis that myenteric plexitis can be predictive of postoperative relapse.