Among patients who have had surgery for Crohn disease, positive resection margins, granulomas, and myenteric plexitis are predictive of postoperative recurrence of the disorder, according to a study published in Clinical Gastroenterology and Hepatology.

Researchers searched electronic databases through February 2020 to identify studies that evaluated the risk of clinical, endoscopic, or surgical postoperative recurrence of Crohn disease in patients with positive resection margins, plexitis, or granulomas in the index specimen. A total of 21 studies including 2481 patients were identified that assessed positive resection margins. Ten studies including 808 patients evaluated plexitis, and 19 studies including 1777 patients assessed granulomas.

After calculating pooled risk ratios (RR), the investigators found that compared with negative margins, positive resection margins increased the clinical recurrence risk of Crohn disease (RR 1.26; 95% CI, 1.06-1.49; I2 = 41%) and surgical recurrence (RR 1.87; 95% CI, 1.14-3.08; I2 = 71%). A trend was observed toward endoscopic recurrence (RR 1.56; 95% CI, 0.79-3.05; I2 = 85%).

The presence of plexitis increased the risk of endoscopic recurrence (RR 1.31; 95% CI, 1.00-1.72: I2 = 20%), compared with the absence of plexitis, and a trend toward clinical recurrence was observed (RR 1.34; 95% CI, 0.95-1.91; I2 = 46%).


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In addition, compared with the absence of granulomas, the presence of granulomas increased the risk of clinical recurrence (RR 1.31; 95% CI, 1.05-1.64; I2 = 36%) and endoscopic recurrence (RR 1.37; 95% CI, 1.00-1.87; I2 = 49%), and a trend was noted toward surgical recurrence (RR 1.58; 95% CI, 0.89-2.80; I2 = 75%).

“Overall, we demonstrate that positive resection margins, myenteric plexitis at the margin, and granulomas within the resection specimen increase the risk of post-operative Crohn disease recurrence,” stated the study authors.

The investigators noted some limitations to their findings, such as most studies included in the analysis were retrospective without appropriate adjustments for potential confounding factors and multivariable analyses were not available or conducted in a majority of the included studies.

“Until future studies can identify 1 particular histological feature that is strongly associated with postoperative recurrence, we believe ongoing global risk assessments, incorporating patient-specific clinical factors, such as smoking history, history of penetrating disease, and perianal Crohn disease, in addition to these histological features, may allow for a more accurate identification of patients at high risk of postoperative recurrence and on appropriateness of early medical therapy with close follow-up,” the researchers concluded.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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Reference

Tandon P, Malhi G, Abdali D, et al. Active margins, plexitis, and granulomas increase post-operative Crohn’s recurrence: Systematic review and meta-analysis [published online August 12, 2020]. Clin Gastroenterol Hepatol. doi: 10.1016/j.cgh.2020.08.014