Extended mesenterectomy or mesenteric-sparing surgery in Crohn’s disease?

Extended mesenterectomy did not outperform mesenteric-sparing surgery in patients with Crohn’s disease (CD) undergoing primary ileocolic resection, data from the international SPICY trial displayed. Therefore, the authors advise to perform mesenteric-sparing surgery in these patients.

“Post-operative recurrence of CD is the standard and not an exception,” stated Dr Eline van der Does de Willebois (Amsterdam University Medical Centers, the Netherlands) [1]. “We should therefore aim to investigate options to prevent post-operative recurrence of CD following ileocolic resection.” It is somewhat unclear whether an extended mesenterectomy or a mesenteric-sparing approach yields better outcomes. It has been suggested that the mesentery could be a driver of disease, whereas others think that the mesentery might be a protective contributor [2,3].

To gain an evidence-based perspective on this matter, the double-blinded, international SPICY trial (NCT04538638) randomised 139 patients with CD undergoing primary ileocolic resection 1:1 to extensive mesenteric resection following the lower border of the ileocolic trunk or mesenteric-sparing ileocolic resection, as is currently advised by guidelines [1]. The primary endpoint was endoscopic recurrence at 6 months after the procedure, defined as a modified Rutgeerts score ≥i2b.

Endoscopic recurrence was reported in 42.4% of the participants in the extended mesenterectomy arm and in 43.1% of the participants in the mesenteric-sparing arm, revealing no clear difference between both arms. Dr van der Does de Willebois added that anastomotic leakage was numerically more common in the extended mesenterectomy arm (7.6% vs 1.5%; P=0.21).

“Since extended mesenterectomy is not superior to a mesenteric-sparing approach and anastomotic leakage may occur more frequently in patients undergoing extended mesenterectomy, we opt for the mesenteric-sparing approach in patients with CD undergoing primary ileocolic resection,” concluded Dr van der Does de Willebois.

1. Van der Does de Willebois E, et al. Mesenteric sparing or extended mesenterectomy in primary ileocolic resection for Crohn’s disease: results of an international randomised controlled trial. OP19, 19^th Congress of ECCO, 21–24 February 2024, Stockholm, Sweden.
2. Coffey CJ, et al. J Crohns Colitis. 2018;12(10):1139-1150.
3. Ha CWY, et al. Cell. 2020;183(3):666-683.e17.

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Posted on 18 April 202418 April 2024