Extended mesenteric excision: long-term outcomes

What is known

• Retrospective cohorts suggested up to a 37% reduction in surgical recurrence with excision of affected mesentery, but no RCT data existed at the time SPICY was designed. ¹
• The SPICY international RCT compared mesenteric-sparing vs extended resection in primary ileocolic resection with postoperative endoscopic recurrence as the endpoint. ¹
• A 2025 systematic review/meta-analysis of 4 studies (632 patients) found no significant difference in endoscopic recurrence between extended and limited mesenteric excision. ²
• Multiple 2025 meta-analyses reach divergent conclusions, with several concluding extended excision does not impact postoperative recurrence or complications. ^2,3

What is unknown / caveats

• Retrospective series report surgical-recurrence reduction that RCT/meta-analytic data do not confirm
• 2025 meta-analyses themselves diverge (some 'no effect', some suggest a surgical-recurrence benefit)
• Pooled meta-analyses rest on few studies and heterogeneous definitions (endoscopic vs surgical recurrence)
• Long-term surgical-recurrence and durability outcomes remain under-reported vs endoscopic endpoints
• Full effect-size/CI details for each meta-analysis and the REMEASURE trial not in the retrieved excerpts
• Whether any subgroup or surgical-recurrence benefit survives beyond the null endoscopic-recurrence finding is unresolved across the 2025 meta-analyses.

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. Maatouk M, Khalifa MB, Essid N, Mabrouk A, Nouira M, Boudokhane M, Moussa MB. Mesenteric inclusion in Crohn's disease surgery: Promising breakthrough or tempest in a teapot? An updated meta-analysis. Surg Open Sci. 2025;28:89-97. PMID: 41403856.

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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.