Severe Myenteric Plexitis at the Proximal Margin Predicts Postoperative Recurrence in Crohn's Disease Irrespective of...

Postoperative clinical recurrence is common in patients with Crohn's disease (CD) despite intestinal resection. Although histopathological findings at resection margins suggestively influence recurrence, their prognostic value remains unclear. This study evaluated the pathological features of the intestinal resection margins in CD and assess their utility in predicting postoperative clinical recurrence.

This retrospective, single-centre cohort study included 224 patients with CD who underwent intestinal resection without visible residual disease at the Tokyo Yamate Medical Center between January 2019 and December 2021. The patients were followed up until July 2024. The histological features at the resection margins, including plexitis, positive margins, granulomas, and lymphoid follicles, were graded using standardised systems. Associations between these histopathological findings, preoperative clinical characteristics, and clinical recurrence were analysed using univariate and multivariate methods; survival analyses used the Kaplan-Meier method and Cox proportional hazards models.

Severe plexitis at the proximal margin was found in 60.3% of cases and was not associated with preoperative clinical factors or distance from macroscopic lesions. Cox regression identified severe plexitis (hazard ratio [HR]: 1.64, 95% confidence interval [CI]: 1.11-2.44, p=0.013) and lack of prophylactic treatment (HR: 1.64, 95% CI: 1.14-2.35, p=0.007) as independent predictors of clinical recurrence. A stepwise relationship was observed between plexitis severity and recurrence risk.

Severe plexitis at the proximal margin is an independent histopathological predictor of CD postoperative clinical recurrence and is unaffected by preoperative factors or resection length, serving as an objective and valuable marker for postoperative risk stratification.