Complete vs limited mesenteric excision and recurrence
Does complete mesenteric excision reduce postoperative recurrence compared with limited mesenteric excision in ileocolic resection for CD
What is known
- SPICY, an international 1:1 RCT (133 patients), found no difference in 6-month endoscopic recurrence between extended and mesenteric-sparing resection (p=1.000), nor in operative time, blood loss, or morbidity. 1,2
- A 2025 systematic review/meta-analysis (4 studies, 632 patients) found no significant difference in endoscopic recurrence between extended and limited mesenteric excision. 3
- The REMEDY retrospective cohort (326 patients) showed similar endoscopic (44.6% vs 46.7%) and ultrasonographic recurrence with mesenteric resection versus retention. 4
- One pooled meta-analysis (Vaghiri, 5 studies, 4358 patients) reported a large surgical-recurrence risk reduction with extended excision but no difference in endoscopic recurrence or morbidity. 2
What is unknown / caveats
- Endoscopic recurrence: no benefit (SPICY RCT + 2 meta-analyses); surgical recurrence: one meta-analysis reports large reduction from retrospective data
- Only one RCT (SPICY) with 6-month endoscopic follow-up; remaining primary studies are retrospective and heterogeneous
- Surgical-recurrence signal derives from non-randomised data not restricted to limited ileocolic disease
- Whether extended excision reduces long-term surgical recurrence remains unresolved. The positive signal is retrospective and not corroborated by randomised endoscopic endpoints.
References
- [No authors listed]. Effect of mesenteric sparing or extended resection in primary ileocolic resection for Crohn's disease on postoperative endoscopic recurrence (SPICY): an international, randomised controlled trial. Lancet Gastroenterol Hepatol. 2024;9(9):793-801. PMID: 39025100.
- Mostafa OES, Zaman S, Malik M, Kumar P, Kumar L, Akingboye A, Sarma D, Peravali R. Clinical outcomes of conventional versus extended mesenteric resection in limited ileo-colonic Crohn's disease: a systematic review and meta-analysis. Int J Colorectal Dis. 2025;40(1):144. PMID: 40528089.
- [No authors listed]. Effect of extensive mesenteric excision on primary ileocolic resection outcomes in Crohn's disease patients: a systematic review with meta-analysis. Int J Colorectal Dis. 2025;40(1):243. PMID: 41329358.
- Mineccia M, Maconi G, Daperno M, Cigognini M, Cherubini V, Colombo F, Perotti S, Baldi C, Massucco P, Ardizzone S, Ferrero A, Sampietro GM. Has the Removing of the Mesentery during Ileo-Colic Resection an Impact on Post-Operative Complications and Recurrence in Crohn's Disease? Results from the Resection of the Mesentery Study (Remedy). J Clin Med. 2022;11(7). PMID: 35407568.
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⚠ Required context not in this corpus (moderate). WITHOUT prophylaxis, ANY endoscopic recurrent lesion in the neoterminal ileum is seen in ~73% within 1 year and ~85% by 3 years of ileocolic resection (Rutgeerts 1990, PMID 2394349). The baseline is the majority, not a minority. (Denominator is any lesion, not a >=i2 cut.)
Why this matters: Understating the untreated recurrence rate makes declining postoperative prophylaxis look reasonable when the expected course is recurrence in most patients.
Added by the landmark interlock. This corpus is surgical in scope and cannot admit the source paper (PMID 2394349). Not generated by the RAG.
Draft, generated by the IBDology RAG and not yet clinician-reviewed. Answers are grounded in the retrieved literature listed above; a high faithfulness score means the answer matches its sources, not that the sources are correct.
Reviewer notes