Presence of granulomas in mesenteric lymph nodes is associated with postoperative recurrence in Crohn's disease

Background: The association between the presence of granulomas in the mesenteric lymph node (MLN) and postoperative recurrent Crohn's disease (CD) is unknown. Our aim was to assess the predictive value of the presence of granulomas in MLN as well as in bowel wall for postoperative recurrence of CD. Methods: Patients with CD who underwent the index ileocolonic resection between 2004 and 2012 were included. Surgical pathology reports were reviewed for the presence and location of granulomas. The status of MLN granulomas was confirmed by re-review of surgical pathology specimen from randomly sampled patients by an expert pathologist. Both univariable and multivariable analyses were performed to assess the risk factors associated with postoperative recurrent CD. Results: A total of 194 patients were included. Granulomas were detected in the MLN in 23 patients (11.9%), and in the intestinal wall in 57 (29.4%). On Kaplan-Meier curve, the presence of granulomas in MLN was found to be a risk factor for postoperative endoscopic recurrence (P 0.015) as well as surgical recurrence (P 0.035). In contrast, granulomas in the bowel wall, which was not found to be associated with neither endoscopic recurrence (P 0.94) or surgical recurrence (P 0.56). On Cox proportional hazards regression analysis, the presence of MLN granulomas was independently associated with an increased risk for both postoperative endoscopic recurrence (hazard ratio [HR] 1.91; 95% confidence interval [CI], 1.06-3.45; P 0.031) and surgical recurrence (HR 3.43; 95% CI, 1.18-9.99; P 0.023). Conclusions: The presence of granulomas in MLN but not in intestine per se was found to be an independent risk factor for recurrence in CD patients undergoing ileocolonic resection.