Letter to the Editor: Mesenteric Lymphatic Vessel Density Is Associated with Disease Behavior and Postoperative Recurrence in Crohn’s Disease

Excerpt

We read with interest the article by Li et al. in the Journal of Gastrointestinal Surgery that reports an association between increased mesenteric lymphatic vessel density in Crohn’s resection specimens and postoperative disease recurrence.¹ One year after the index resection, 11 of 53 patients had clinical recurrence of disease. D2-40 immunohistochemical staining of mesenteric adipose tissue revealed that these patients had increased mesenteric lymphatic vessel density of the proximal mesenteric margin at the time of resection compared to patients with latent disease (6.2% vs 3.3%, p < 0.001). Mesenteric lymphatic density was greatest in those who recurred with a stricturing (10.6%) or penetrating (7.3%) form of the disease. Lymphatic density was also found to correlate with granulomatous disease, fat wrapping, and bowel wall thickness. These novel findings are accompanied by the limitations of small sample size, lack of blinding in pathological examinations, ill-defined clinical endpoints, and retrospective methodology. Despite these drawbacks, we would like to commend the authors for an engaging study that adds significantly to the growing body of data on the pathobiologic role of the mesentery in Crohn’s disease. …