Mesenteric granulomas independently predict long‐term risk of surgical recurrence in Crohn's disease

• Published in: Colorectal disease Vol. 22; no. 2; pp. 170 - 177
• Main Authors: Unger, L. W., Argeny, S., Stift, A., Yang, Y., Karall, A., Freilinger, T., Müller, C., Bergmann, M., Stift, J., Riss, S.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.02.2020; John Wiley and Sons Inc
• Subjects: Adult; Colectomy - adverse effects; Crohn Disease - complications; Crohn Disease - pathology; Crohn Disease - therapy; Crohn's disease; Crohns disease; Female; Follow-Up Studies; Granuloma - etiology; Granuloma - pathology; Humans; Immunosuppressive agents; Immunosuppressive Agents - therapeutic use; Inflammatory bowel disease; Intestinal Diseases - etiology; Intestinal Diseases - pathology; intestinal resection; Intestine; laparoscopy; Male; Mesentery - pathology; Middle Aged; Multivariate Analysis; Original; Peritoneal Diseases - etiology; Peritoneal Diseases - pathology; Postoperative Period; Recurrence; Retrospective Studies; Risk Factors; Secondary Prevention - methods; Severity of Illness Index; Surgery; TNF inhibitors; Treatment Outcome; Tumor necrosis factor; Tumor Necrosis Factor Inhibitors - therapeutic use; Tumor necrosis factor-TNF; Tumors; Inflammatory bowel disease; laparoscopy; intestinal resection
• ISSN: 1462-8910; 1463-1318
• DOI: 10.1111/codi.14814

Aim The risk factors that predict surgical recurrence in Crohn's disease (CD) remain controversial. Postoperative anti‐tumour necrosis factor (anti‐TNF) therapy might lower recurrence rates whilst the presence of mesenteric granulomas has been postulated to increase the risk. We hypothesized that mesenteric granulomas indicate disease severity and might predict the risk of surgical recurrence, irrespective of immunosuppressive therapy. Method We performed a retrospective review of all consecutive patients undergoing operations for CD between January 2000 and December 2014 at a single tertiary referral centre and assessed the perioperative factors and histological findings at the time of surgery. Surgical recurrence rates and the immunosuppressive regimen were assessed through retrospective chart review and telephone interviews. Results A total of 274 patients were eligible for analysis. Median follow‐up was 8.54 (5.48–14.42) years. A total of 63 patients (23.0%) underwent surgery for recurrent CD after a median of 4.75 (2.10–7.96) years. In final histology, 35 (12.8%) patients had mesenteric granulomas. TNF inhibitors were administered postoperatively in 104 (38.0%) and thiopurines in 137 (50.0%) patients. In univariate analysis, only the presence of mesenteric granulomas [hazard ratio (HR) 1.95; 95% CI 1.05–3.62; P = 0.035] significantly increased the risk for recurrent surgery while postoperative anti‐TNF (HR 0.85; 95% CI 0.49–1.50; P = 0.581) or thiopurine therapy (HR 1.03; 95% CI 0.61–1.73; P = 0.916) did not. In multivariate analysis, only the presence of mesenteric granulomas significantly influenced the risk of surgical recurrence (HR 1.94, 95% CI 1.04–3.60; P = 0.037). Conclusion Intestinal and mesenteric granulomas should be differentiated in pathology reports, because mesenteric, but not intestinal, granulomas may be associated with an increased risk of surgical recurrence.