title: Myenteric plexitis is a risk factor for endoscopic and clinical postoperative recurrence after ileocolonic resection in Crohn's disease.
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.
  
  
  OBJECTIVE
  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.
  
  
  CONCLUSIONS
  Myenteric plexitis in proximal margins of ileocolonic resection specimens is independently associated with endoscopic and clinical postoperative recurrence in Crohn's disease.
authors.affiliation: Pathology Department, University Hospital Estaing, Clermont-Ferrand, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Decousus
authors.affiliation: Gastroenterology Department, University Hospital Estaing, Clermont-Ferrand, France.
authors.forename: Anne-Laure
authors.initials: AL
authors.lastname: Boucher
authors.affiliation: Pathology Department, University Hospital Estaing, Clermont-Ferrand, France.
authors.forename: Juliette
authors.initials: J
authors.lastname: Joubert
authors.affiliation: DRCI, Biostatistics Unit, GM Clermont-Ferrand University and Medical Center, Clermont-Ferrand, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Pereira
authors.affiliation: Digestive Surgery Department, University Hospital Estaing, Clermont-Ferrand, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Dubois
authors.affiliation: Gastroenterology Department, University Hospital Estaing, Clermont-Ferrand, France.
authors.forename: Felix
authors.initials: F
authors.lastname: Goutorbe
authors.affiliation: Pathology Department, University Hospital Estaing, Clermont-Ferrand, France.
authors.forename: Pierre J
authors.initials: PJ
authors.lastname: Déchelotte
authors.affiliation: 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.
authors.forename: Gilles
authors.initials: G
authors.lastname: Bommelaer
authors.affiliation: 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.
authors.forename: Anthony
authors.initials: A
authors.lastname: Buisson
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D003082:Colectomy / Q000009:adverse effects* / Q000379:methods; D003106:Colon / Q000473:pathology* / Q000601:surgery; D003424:Crohn Disease / Q000601:surgery*; D016208:Databases, Factual; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D007082:Ileum / Q000473:pathology* / Q000601:surgery; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009197:Myenteric Plexus / Q000473:pathology*; D009443:Neuritis / Q000175:diagnosis*; D011184:Postoperative Period; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: Crohn's disease; Plexitis; Postoperative recurrence; Risk factors