P190. Myenteric plexitis at resection margins as a predictive marker for early recurrence in Crohn's disease
H. Misteli1, C. Koh2, L. Wang3, B. George1, R. Guy1, A. Szuts3, S. Olonso-Goncalves3, A. Tzivinakis3, N. Mortensen1, 1The Churchill Hospital, Oxford University Hospital, Department of Colorectal Surgery, Oxford, United Kingdom, 2Royal Prince Alfred Hospital, Surgical Outcomes Research Centre, Sidney, Australia, 3John Radcliffe Hospital Oxford University Hospital, Department of Cellular Pathology, Oxford, United Kingdom
Recurrence following surgery for Crohn's Disease (CD) can occur in up to 50–70% of patients. The morbidity from symptoms of recurrence and potential sequel from repeated surgical intervention makes it logical and rational to identify markers that may predict for recurrence which may permit tailored surveillance or medical therapy for those at high risk of recurrence. Myenteric Plexitis (MP) at the resection margin was previously found to be associated with early endoscopic CD recurrence although its relationship with clinical or surgical recurrence remains unclear. The purpose of this study was to investigate the association between MP and disease recurrence.
Consecutive patients who underwent primary ileocaecal resection for CD at a single tertiary referral center between 2000 and 2010 were retrospectively reviewed. Information on demographics, surgical details and disease recurrence were retrieved by medical chart review. Clinical recurrence was defined symptomatic recurrence with radiological and/ or endoscopic evidence to support disease recurrence whereas surgical recurrence is clinical recurrence requiring surgical intervention. MP was assessed both at the proximal and distal resection margins by an experienced pathologist using current grading systems.
There were 87 patients (37 men) with a median age of 31.5. Of these, 31 (35.6%) had evidence of recurrence. Clinical and surgical recurrence occurred in 15 (17.2%) and 16 (18.4%) respectively. Seventy seven specimens could be assessed for MP. Of these 54 (70.1%) showed moderate and 23 (29.9%) severe MP (grade 2 and 3). The presence of MP at the proximal margin is associated with the presence of MP at the distal resection margin (p = 0.003) and granuloma at the proximal margin (p = 0.032). MP does not appear to be associated with conventionally accepted clinical markers of recurrence such as age, smoking or type of disease. Severe MP is associated both with clinical as well as surgical recurrence (p = 0.04).
The presence of severe MP at the proximal resection margin in CD patients is associated with clinical and surgical recurrence. The prognostic value of MP continues to be investigated in a prospective setting.