Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jul 27, 2017; 9(7): 167-173
Published online Jul 27, 2017. doi: 10.4240/wjgs.v9.i7.167
Analysis of risk factors - especially different types of plexitis - for postoperative relapse in Crohn’s disease
Ágnes Milassin, Anita Sejben, László Tiszlavicz, Zita Reisz, György Lázár, Mónika Szűcs, Renáta Bor, Anita Bálint, Mariann Rutka, Zoltán Szepes, Ferenc Nagy, Klaudia Farkas, Tamás Molnár
Ágnes Milassin, Renáta Bor, Anita Bálint, Mariann Rutka, Zoltán Szepes, Ferenc Nagy, Klaudia Farkas, Tamás Molnár, First Department of Internal Medicine, University of Szeged, 6720 Szeged, Hungary
Anita Sejben, László Tiszlavicz, Zita Reisz, Department of Pathology, University of Szeged, 6720 Szeged, Hungary
György Lázár, Department of Surgery, University of Szeged, 6720 Szeged, Hungary
Mónika Szűcs, Department of Medical Physics and Informatics, University of Szeged, 6720 Szeged, Hungary
Author contributions: Milassin Á, Sejben A, Tiszlavicz L, Reisz Z, Farkas K and Molnár T designed the research; Milassin Á, Sejben A and Zita R performed the research; Tiszlavicz L, Lázár G and Molnár T supervised the report; Szűcs M contributed to the statistical analysis; Bor R, Rutka M, Bálint A, Szepes Z, Nagy F and Molnár T provided clinical advice; Milassin Á wrote the paper.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of University of Szeged.
Informed consent statement: Patients were not required to give informed consent to the study because the data were collected retrospectively, and the analysis used anonymous clinical data. Each patient gave their informed consent to the treatment.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ágnes Milassin, MD, First Department of Internal Medicine, University of Szeged, Korányi fasor 8-10, 6720 Szeged, Hungary. milassin.agnes.eszter@med.u-szeged.hu
Telephone: +36-62-545186 Fax: +36-62-545185
Received: January 27, 2017
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
Abstract
AIM

To evaluate the presence of submucosal and myenteric plexitis and its role in predicting postoperative recurrence.

METHODS

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.

RESULTS

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.

CONCLUSION

The presence of severe submucosal plexitis with lymphocytes in the proximal resection margin is more likely to result in postoperative relapse in CD.

Keywords: Submucosal plexitis, Postoperative recurrence, Crohn’s disease, Stricturing disease behavior, Isolated ileal disease

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.