Association Between Microscopic Lesions at Ileal Resection Margin and Recurrence After Surgery in Patients With Crohn’s Disease

Nassim Hammoudi (1, 2) , Dominique Cazals-Hatem (3) , Claire Auzolle (1, 2) , Charlotte Gardair (4) , Marjolaine Ngollo (1) , Hugo Bottois (1) , Stéphane Nancey (5) , Benjamin Pariente (6) , Anthony Buisson (7) , Xavier Tréton (8) , Mathurin Fumery (9) , Madeleine Bezault (1) , Philippe Seksik (10) , Lionel Le Bourhis (1) , Jean-François Fléjou (11) , Matthieu Allez (1, 2) , Pierre Cattan , Mircea Chirica , Nicolas Munoz-Bongrand , Hélène Corte , Nathan Beaupel , Jonathan Catry , Jean-Marc Gornet , Clotilde Baudry , Nelson Lourenco , Mariane Maillet , My-Linh Tran-Minh , Victor Chardiny , Céline Grand , Brice Gergaud , Joelle Bonnet , Leila Chedouba , Andrée Nisard , Laurent Beaugerie , Harry Sokol , Anne Bourrier , Isabelle Nion-Larmurier , Julien Kirchgesner , Elodie Quévrain , Loic Brot , Najim Chafai , Jérémie Lefèvre , Emmanuel Tiret , Magali Svrcek , Nathalie Guedj , Yves Panis , Leon Magiorri , Marianne Ferron , Yoram Bouhnik , Olivier Corcos , Carmen Stefanescu , Philippe Marteau , Xavier Dray , Ulrika Chaput , Rachid Kaci , Anne Dubois , Gilles Bommelaer , Marion Goutte , Nicolas Barnich , Dilek Coban , Catherine Godfraind , Juliette Joubert Zakeyh , Pierre Desreumaux , Maria Nachury , Coralie Sommeville , Florence Renaud , Jean-Louis Dupas , Julien Loreau , Franck Brazier , Denis Chatelain , Christophe Attencourt , Charles Sabbagh , Martine Leconte , Gilles Boschetti , Bernard Flourie , Yves François , Eddy Cotte , Anne Charlois , Peggy Falgon , Helena Hadjisavvas , Driffa Moussata , Marion Chauvenet , Sarah Boyer , Alexandra Traverse-Glehen , Xavier Hébuterne , Jérome Filippi , Paul Hofmann , Amine Rahili , Stéphanie Patouraux , Xavier Jouven

1 EMily (UMR_S_1160 / U1160) - Ecotaxie, microenvironnement et développement lymphocytaire
2 Service d'hépato-gastro-entérologie
3 Département de Pathologie [Hôpital Beaujon]
4 Laboratoire de pathologie [AP-HP Hôpital Saint-Louis]
5 APY - Autophagie infection et immunité - Autophagy Infection Immunity
6 Service d'Hépato-gastroentérologie
7 M2iSH - Microbes, Intestin, Inflammation et Susceptibilité de l'Hôte
8 Service de Gastroentérologie [Hôpital Beaujon]
9 Service d'Hépato Gastroenterologie [CHU Amiens-Picardie]
10 LBM UMR 7203 - Laboratoire des biomolécules
11 CHU Saint-Antoine [AP-HP]

Background and AimsDifferent types of histologic lesions at the ileal margin, detected by histology, have been associated with increased rates of recurrence after ileocaecal surgery in patients with Crohn’s disease (CD). We aimed to characterize histologic features of the ileal margin and to evaluate their association with disease recurrence.MethodsWe collected histologic data from 211 patients with ileal or ileocolonic CD who underwent ileocolonic resections at hospitals in France from September 2010 through December 2016. Ileal margins were analyzed. Early endoscopic recurrence was defined by a Rutgeerts score of i2 or more, 6 months after surgery. We also collected data from 10 adults with healthy ileum who underwent ileocecal resection for colonic tumors (controls). Clinical relapse was defined by CD-related symptoms confirmed by imaging, endoscopy, therapy intensification, CD-related complication, or subsequent surgery.ResultsSix months after surgery, 49% of patients had endoscopic recurrence; 5 years after surgery, 57% of patients had clinical relapse. Ileal margins were macroscopically affected in 20.9% of patients. CD transmural lesions at the margin (defined by mucosal ulceration or cryptitis, submucosal fibrosis and lymphoplasmacytic infiltrate of the subserosa) were observed in 13.6% of patients. Endoscopic recurrence was observed in 75% of patients with CD transmural lesions vs 46% of patients without (P =.005). In multivariate analysis, CD transmural lesions at the margin were independently associated with early endoscopic recurrence (OR, 3.83; 95% CI, 1.47-11.05; P =.008) and clinical recurrence (OR 2.04; 95% CI, 1.09-3.99; P =.026).ConclusionIn patients with CD, transmural lesions at the ileal margin were associated with an increased risk of post-operative recurrence. Histologic features of the ileal margin should be included in making decisions about post-operative therapy.

Keywords: Outcome; REMIND Trial; Prognostic Factor; IBD Surgery

Domains: Molecular biology; Bacteriology

Nassim Hammoudi, Dominique Cazals-Hatem, Claire Auzolle, Charlotte Gardair, Marjolaine Ngollo, et al.. Association Between Microscopic Lesions at Ileal Resection Margin and Recurrence After Surgery in Patients With Crohn’s Disease. Clinical Gastroenterology and Hepatology, 2019, ⟨10.1016/j.cgh.2019.04.045⟩. ⟨hal-02193633⟩