Mesenteric excision or preservation in penetrating CD

What is known

• SPICY, an international RCT, directly compared mesenteric sparing versus extended mesenteric resection in primary ileocolic resection using postoperative endoscopic recurrence as the endpoint. ¹
• Retrospective cohorts suggested extended excision could reduce surgical recurrence by up to ~37%, but no RCT data supported this before SPICY. ¹
• 2025 meta-analyses conflict, some report extended excision reduces surgical recurrence, another finds no impact on recurrence or complications. ²
• Correspondence on SPICY flags higher anastomotic leak rates in the extended-excision arm and questions the specimen-length data, alongside ECCO guidance favoring leaving the mesentery in situ. ^1,3

What is unknown / caveats

• Retrospective cohorts and some 2025 meta-analyses favor extended excision for recurrence; other 2025 meta-analysis and the SPICY RCT do not
• None of the retrieved evidence is specific to penetrating phenotype or short-segment terminal ileal disease
• Excerpts report SPICY's design and correspondence but not its final numeric recurrence outcome directly
• Whether any recurrence benefit of extended excision exists in the penetrating, short-segment subgroup is not addressed by the retrieved evidence.

References

1. [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.

2. [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.

3. van der Does de Willebois EML, Bemelman WA, Buskens CJ. Mesenteric sparing or extended resection in primary ileocolic resection for Crohn's disease - Authors' reply. Lancet Gastroenterol Hepatol. 2025;10(1):16-17. PMID: 39674214.

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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.