Inclusion of the Mesentery in Ileocolic Resection for Crohn’s Disease is Associated With Reduced Surgical Recurrence
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Open Access
- 4 January 2018
- journal article
- research article
- Published by Oxford University Press (OUP) in Journal of Crohn's and Colitis
- Vol. 12 (10), 1139-1150
- https://doi.org/10.1093/ecco-jcc/jjx187
Abstract
Background and Aims: Inclusion of the mesentery during resection for colorectal cancer is associated with improved outcomes but has yet to be evaluated in Crohn's disease. This study aimed to determine the rate of surgical recurrence after inclusion of mesentery during ileocolic resection for Crohn's disease. Methods: Surgical recurrence rates were compared between two cohorts. Cohort A [n = 30] underwent conventional ileocolic resection where the mesentery was divided flush with the intestine. Cohort B [n = 34] underwent resection which included excision of the mesentery. The relationship between mesenteric disease severity and surgical recurrence was determined in a separate cohort [n = 94]. A mesenteric disease activity index was developed to quantify disease severity. This was correlated with the Crohn's disease activity index and the fibrocyte percentage in circulating white cells. Results: Cumulative reoperation rates were 40% and 2.9% in cohorts A and B [P = 0.003], respectively. Surgical technique was an independent determinant of outcome [P = 0.007]. Length of resected intestine was shorter in cohort B, whilst lymph node yield was higher [12.25 +/- 13 versus 2.4 +/- 2.9, P = 0.002]. Advanced mesenteric disease predicted increased surgical recurrence [Hazard Ratio 4.7, 95% Confidence Interval: 1.71-13.01, P = 0.003]. The mesenteric disease activity index correlated with the mucosal disease activity index [r = 0.76, p < 0.0001] and the Crohn's disease activity index [r = 0.70, p < 0.0001]. The mesenteric disease activity index was significantly worse in smokers and correlated with increases in circulating fibrocytes. Conclusions: Inclusion of mesentery in ileocolic resection for Crohn's disease is associated with reduced recurrence requiring reoperation.Keywords
Funding Information
- University of Limerick
This publication has 82 references indexed in Scilit:
- Surgical recurrence after primary ileocolic resection for Crohn’s diseaseTechniques in Coloproctology, 2013
- Fibrocytes Are Involved in Inflammation as well as Fibrosis in the Pathogenesis of Crohn’s DiseaseDigestive Diseases and Sciences, 2013
- Origin of myofibroblasts in liver fibrosisFibrogenesis & Tissue Repair, 2012
- Visceral adipocytes: old actors in obesity and new protagonists in Crohn's disease?Gut, 2011
- Restorative Operations for Crohn's DiseaseClinics in Colon and Rectal Surgery, 2007
- Colonic Crohn's DiseaseClinics in Colon and Rectal Surgery, 2007
- StrictureplastyClinics in Colon and Rectal Surgery, 2007
- Mesenteric fat in Crohn's disease: a pathogenetic hallmark or an innocent bystander?Gut, 2007
- Circulating peripheral blood fibrocytes in human fibrotic interstitial lung diseaseBiochemical and Biophysical Research Communications, 2007
- Risk factors for surgery and recurrence in 907 patients with primary ileocaecal Crohn's diseaseBritish Journal of Surgery, 2000