Evidence map›Paper›PMID 31393663›Full record

ArticleColorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland2020

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

L W Unger, S Argeny, A Stift, Y Yang, A Karall, T Freilinger, C Müller, M Bergmann, J Stift, S Riss

Abstract readEvaluation Study
In one paragraph

Article in Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it.

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4 · The record

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PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

L W UngerDivision of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.ORCID 0000-0002-8423-2268
S ArgenyDivision of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.ORCID 0000-0002-4342-0350
A StiftDivision of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.ORCID 0000-0002-7243-8138
Y YangDivision of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.
A KarallDivision of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.
T FreilingerDivision of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.
C MüllerDivision of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.
M BergmannDivision of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.ORCID 0000-0001-8529-1166
J StiftClinical Institute of Pathology, Medical University of Vienna, Vienna, Austria.ORCID 0000-0001-5334-9343
S RissDivision of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimThe 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.

methodWe 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.

resultsA 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).

conclusionIntestinal 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.

Indexed as

AdultColectomyCrohn DiseaseFemaleFollow-Up StudiesGranulomaHumansImmunosuppressive AgentsIntestinal DiseasesMaleMesenteryMiddle AgedMultivariate AnalysisPeritoneal DiseasesPostoperative PeriodRecurrenceImmunosuppressive AgentsTumor Necrosis Factor InhibitorsInflammatory bowel diseaseintestinal resectionlaparoscopy

Identifiers

PMID31393663
PMCPMC7028106

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.