P127 Predictive role of penetrating disease behaviour, ileal localisation, female gender, and plexitis in the postoperative recurrence of Crohn’s disease
A. Milassin*1, A. Sejben2, Z. Reisz2, L. Tiszlavicz2, G. Lázár3, R. Bor1, A. Bálint1, M. Rutka1, Z. Szepes1, K. Farkas1, T. Molnár1
1University of Szeged, First Department of Internal Medicine, Szeged, Hungary, 2University of Szeged, Department of Pathology, Szeged, Hungary, 3University of Szeged, Department of Surgery, Szeged, Hungary
Surgery is not curative in Crohn’s disease (CD); hence, postoperative recurrence remains a significant problem. Currently, conflicting data are available about the role of the clinical and histological findings in CD postoperative relapse. However, according to the latest data, presence of submucosal or myenteric plexitis can be predictive for postoperative relapse. We evaluated the frequency and predictors of postoperative recurrence and the role of the presence of submucosal and myenteric plexitis in predicting postoperative recurrence based on endoscopic findings and/or the need for additional surgical resection.
Data from all patients who underwent CD-related resection at the University of Szeged, Hungary between 2004 and 2014, were analysed retrospectively. Demographic data, smoking habits, previous resection, treatment before and after the surgery, resection margins, neural fibre hyperplasia, and submucosal and myenteric plexitis were evaluated as possible predictors on postoperative recurrence. Patients were controlled by colonoscopy regularly after surgery. Postoperative recurrence was defined based on the endoscopic findings and/or the need for additional surgical resection.
Included in the study were 104 patients. Ileocecal, colonic, and small bowel resection were performed in 66.3%, 30.7%, and 3% of the cases, respectively. Mean disease duration at the time of surgery was 6.25 years. Amongst patients, 26 underwent previous CD-related surgery; 43.2% of the patients was on 5-aminosalicylate, 20% on corticosteroid, 68.3% on immunomodulant, and 4% on anti-TNF-alpha postoperative treatment. Postoperative recurrence occurred in 63.5% of the patients, whereas 92% relapsed within 5 years after the resection, and a second surgery was needed in 38% of the cases. Mean disease duration for endoscopic relapse was 2.19 years. Moreover, 31 patients were investigated for the presence of plexitis. Predictors for postoperative recurrence were female gender (OR = 2.21, 95% CI 0.98–5.0, p = 0.056), penetrating disease behaviour (OR = 9.01, 95% CI 0.91–90.91, p = 0.06), and isolated ileal localisation (OR = 6.41, 95% CI 1.00–41.67, p = 0.05). No association was revealed between postoperative recurrence and smoking status, previous resection, treatment before and after the surgery, resection margins, neural fibre hyperplasia, and the presence of submucosal or myenteric plexitis and relapse.
Previous CD-related surgery, penetrating behaviour, and isolated ileal localisation proved predictors of postoperative recurrence of CD. Our results did not confirm the hypothesis about the predictive role of plexitis in postoperative relapse; however, further investigations are in progress.