[768] Plexitis at Primary Ileocaecal Resection Margins as Predictive Factor for Subsequent Recurrence in Crohn's Disease

Lai M Wang, Cherry E Koh, Aron Szuts, Sandra Olonso-Goncalves, Alex Tzivinakis, Heidi Misteli, Richard Guy, Bruce George, Neil J Mortensen. John Radcliffe Hospital Oxford University Hospital, Oxford, United Kingdom; Royal Prince Alfred Hospital, Sydney, Australia

Background: 50-90% Crohn's patients experience disease recurrence after surgery requiring further treatment. Predictive histological factors are sought to identify patients at high risk of recurrence for maintenance therapy to prevent subsequent Crohn's related complication and repeated surgery. We investigate the relationship between plexitis and subsequent recurrence suggested by Ng [2009].
Design: Primary ileocolic resections identified from pathology database 2000–2010 with slides of excision margins available were examined (2 pathologists LMW & AS). Myenteric plexus at the margins was assessed for plexitis (presence of 1 or more chronic inflammatory cells in contact with or within ganglion cells or nerve bundles) and graded in the most severe areas (mild G1 <4 cells /HPF, G2 4-9/HPF & G3 >10/HPF) [Ferrante 2006]. Clinical data was obtained from clinical notes, endoscopy and radiology reports. Clinical recurrence (CR) is presence of symptoms attributable to Crohn's disease requiring investigation and confirmed on radiology/endoscopy. Surgical recurrence (SR) is needing repeat surgical intervention.
Results: Of the 87 patients (37 men, 50 women; median age 31.5, ±14.0), 56 (64.4%) patients were free from recurrence, 16 (18.4%) had SR and 15 (17.2%) had CR. Plexitis and granulomas at proximal and distal margins are shown in Table 1.

Table 1 Myenteric plexitis & presence of granulina at Proximal & Distal margins
 PROXIMAL MARGINDISTAL MARGIN
PLEXITIS(%) [77*/87](%) [78 */87]
G023 (29.9)38 (48.7)
G131 (40.3)33 (42.3)
G214 (18.2)6 (7.8)
G39 (11.7)1 (1.2)
GRANULOMAS(%) 84/87(%) 83/87
Present7 (8.3)2 (2.4)
*no. of cases with preserved myenteric plexus

Fistulating disease is associated with recurrence (p = 0.047), proximal plexitis is associated with distal plexitis (p =0.003) and granuloma is associated with plexitis (p = 0.032) by univariate analysis. Severe plexitis at proximal margin is associated with increased risk of subsequent surgical recurrence Table2.

Table2. Univariate analyses between G2&3 plexitis & the following variables
 P value (χ²)
 Any recurrenceSurgical recurrence
Proximal plexitis0.5670.238
G20.3600.082
G30.0400.033
Distal plexitis0.9100.361
G20.6840.770
G30.4540.633
Proximal granuloma0.6840,442
Distal granuloma0.2870.497



Conclusions: Severe myenteric plexitis at the proximal resection margin of primary ileocaecal resections is a predictive factor for any recurrence, surgical or clinical.
Category: Gastrointestinal

Tuesday, March 5, 2013 1:00 PM

Poster Session IV # 124, Tuesday Afternoon

 

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