Submucosal Plexitis as a Predictor of Postoperative Surgical Recurrence in Crohn's Disease

BACKGROUND: The presence of submucosal or myenteric plexitis was associated with clinical and endoscopic Crohn's disease (CD) recurrence after ileocolonic resection. We assessed the value of both submucosal and myenteric plexitis for predicting postoperative surgical recurrence in CD. METHODS: We performed a retrospective study using the database of the Department of Pathology of Nancy University Hospital. All patients who underwent CD-related resection between 1996 and 2008 were analyzed. The proximal resection margin was analyzed blindly by 2 expert pathologists. Plexitis was evaluated by counting each cell type (mast cell, plasmocyte, lymphocyte, eosinophil, and neutrophil) in both submucosal and myenteric plexuses. The optimal cut-off value for each cell type was determined by using receiver operating characteristic analysis. Cox proportional hazards regression analysis was used to identify independent predictors of the second CD-related surgery. RESULTS: Sixty-seven patients were included in the study. Median duration of follow-up was 46 months. Using Kaplan-Meier survival analysis, the proportion of patients without second surgery was 68% at 5 years. In multivariate analysis, using Cox proportional hazards regression analysis, early surgical revision after the first ileocecal resection (hazard ratio = 9.56; 95% confidence interval, 2.02-45.19; P = 0.0046), the presence of at least one eosinophil in the submucosal plexus (hazard ratio = 8.02; 95% confidence interval, 1.87-34.47; P = 0.0054), and the presence of more than 6 lymphocytes in the submucosal plexus (hazard ratio = 5.84; 95% confidence interval, 1.23-27.65; P = 0.0269) were independently associated with risk of surgical recurrence. CONCLUSIONS: Early surgical revision and submucosal plexitis in proximal margins of ileocolonic resection specimens are independently associated with CD surgical recurrence.