Extensive mesenteric excision and postoperative recurrence
In patients undergoing ileocolic resection for CD, does extensive mesenteric excision reduce postoperative recurrence
What is known
- SPICY was an international RCT randomizing patients 1:1 to extended mesenteric resection versus conventional mesenteric-sparing resection with postoperative endoscopic recurrence as the endpoint. 1
- The original signal favoring mesenteric inclusion came from retrospective work (Coffey et al.) associating it with reduced surgical recurrence. 2,3
- A 2025 systematic review with meta-analysis evaluated extensive mesenteric excision on primary ileocolic resection outcomes, and additional trial data (MESOCOLIC) address mesenteric-based surgery. 4
What is unknown / caveats
- Retrospective data (Coffey) suggest benefit; prospective RCT design (SPICY) tested but the excerpts do not report a confirmatory recurrence reduction
- Retrieved excerpts give SPICY's design/background but not its numeric recurrence results or effect estimate
- MESOCOLIC and the 2025 meta-analysis are cited only by title/reference, without pooled outcome data in the excerpts
- No data on complication or morbidity tradeoffs of extended excision in the retrieved chunks
- The excerpts describe the trials but do not contain their quantitative recurrence outcomes, so the magnitude of any effect cannot be stated.
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.
- [No authors listed]. Inclusion of the Mesentery in Ileocolic Resection for Crohn's Disease is Associated with Reduced Surgical Recurrence: Editorial by Coffey et al. J Crohns Colitis. 2018;12(10):1137-1138. PMID: 30137343.
- Ryan ÉJ, Orsi G, Boland MR, Syed AZ, Creavin B, Kelly ME, Sheahan K, Neary PC, Kavanagh DO, McNamara D, Winter DC, O'Riordan JM. Meta-analysis of early bowel resection versus initial medical therapy in patient's with ileocolonic Crohn's disease. Int J Colorectal Dis. 2020;35(3):501-512. PMID: 31915984.
- [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.
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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