Myenteric plexitis at the proximal resection margin is a predictive marker for surgical recurrence of ileocaecal Crohn's disease

Abstract Background Intestinal resection in Crohn’s disease (CD) is not curative and the risk for postoperative recurrence (POR) remains high. Highlighting risk factors for POR is crucial for the postoperative management of CD patients. Myenteric plexitis is a well-established risk factors for POR. The primary purpose of this study was to evaluate the correlation of neuropeptide P (NPY)-, vasoactive intestinal peptide (VIP)- and substance P (SP)-ergic nerve density with the presence and severity of plexitis in myenteric and submucosal plexuses in the proximal resection margin. Secondary aims were to assess the value of abovementioned neuropeptides’ expression in predicting POR and to recognize additional risk factors. Methods We conducted a retrospective, single-center study on CD patients who underwent ileocolonic resection (ICR) between January 2010 and December 2016. Exclusion criteria were age <16 years, patients with missing or invalid data precluding analysis, the presence of a diverting ileostomy on enrollment and specimens inappropriate for the evaluation of histologic features of interest in the proximal resection margin. Demographic and clinical data were retrieved, and the incidence or endoscopic, clinical and surgical POR was recorded. The presence and severity of plexitis was evaluated by hematoxylin and eosin staining. Giemsa staining was used for the recognition of mast cells. Immunohistochemistry was used was used for the detection of T-lymphocytes and NPY-, VIP- and SP-ergic neurons. The expression of the above peptides was quantified using image analysis. Results Seventy-nine patients (44 males) with a median age of 35 years were included. The median follow-up was 71 months. Myenteric and submucosal plexitis were present in 83.5% and 73.4% of patients, respectively. No association was detected between the density of NPY, VIP and SP expression and the presence or severity of plexitis. Similarly, the number of the involved T-lymphocytes or mast cells was not correlated with the expression of these peptides. Univariate and multivariate Cox proportional regression analysis was performed for the detection of risk factors for POR. Smoking and moderate/severe myenteric plexitis were independent risk factors for endoscopic and clinical POR, whereas an involved ileal margin was recognized as a risk factor for clinical POR. Conclusion This study did not document a correlation between plexitis in proximal resection margin and the expression of specific neuropeptides. According to our findings, smoking, myenteric plexitis, and involved ileal margin are independent risk factors for POR.

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A positive proximal resection margin is associated with anastomotic complications following primary ileocaecal resection for Crohn’s disease

International Journal of Colorectal Disease ◽

10.1007/s00384-019-03358-3 ◽

2019 ◽

Vol 34 (9) ◽

pp. 1585-1590 ◽

Cited By ~ 2

Author(s):

Eleonora Garofalo ◽

Alessio Lucarini ◽

Karen G. Flashman ◽

Valerio Celentano

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Resection Margin ◽

Anastomotic Complications ◽

Proximal Resection Margin

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P215 The effect of resection margin involvement of Crohn’s disease on the surgical and clinical recurrence after intestinal surgery

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.344 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S249-S249

Author(s):

J H Seo ◽

J L Lee

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Confidence Interval ◽

Resection Margin ◽

Intestinal Surgery ◽

Repeat Surgery ◽

Clinical Recurrence ◽

Margin Involvement ◽

Surgical Recurrence ◽

Increased Risk

Abstract Background Approximately 80% of patients with Crohn’s disease (CD) require major intestinal surgery during their lifetime and a quarter of patients will undergo repeat surgery within 5 years of the index surgery. For this reason, operative treatment of CD has been the bowel-sparing approach for several decades. This study evaluated the effects of the Crohn’s disease involvement of resection margin on clinical and surgical recurrence. Methods This retrospective study analysed 803 patient who underwent intestinal surgery for CD between January 2006 and December 2015. The CD involvement of resection margin was defined as microscopic involvement from the pathologic reports and grossly involvement from the operative records. Anastomosis recurrence was reviewed using the operative records and radiologic findings including colonoscopy, computed tomography and magnetic resonance imaging. Results In total, 41 patients (5.1%) had an active CD in the bowel resection margin – 31 patients (3.9%) with histologically, 10 patients (1.2%) with grossly. We had 221 (26.8%) reoperation cases, of which 87 (10.6%) patients were an anastomotic recurrence. When patients were stratified by surgical recurrence at anastomosis, the increased risk was not significant in resection margin positive grossly (odds ratio [OR], 3.65; 95% confidence interval [CI], 0.93–14.41) and in microscopic (OR, 1.26; 95% CI, 0.43–3.70) comparing with negative resection margin. Also, resection margin involvement was not related with clinical recurrence grossly (OR, 0.30; 95% confidence interval [CI], 0.07–1.26) and in microscopic (OR, 0.50; 95% CI, 0.21–1.17) Conclusion The current practice suggests the CD involvement of resection margin, even grossly or microscopic, do not influence surgical and clinical recurrence.

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