Clinical outcomes of conventional versus extended mesenteric resection in limited ileo-colonic Crohn's disease: a systematic review and meta-analysis
Mostafa, Omar E S Zaman, Shafquat Malik, Maymunah Kumar, Prajeesh Kumar, Lalit Akingboye, Akinfemi Sarma, Diwakar Peravali, Rajeev
Mostafa, Omar E S
Zaman, Shafquat
Malik, Maymunah
Kumar, Prajeesh
Kumar, Lalit
Akingboye, Akinfemi
Sarma, Diwakar
Peravali, Rajeev
Affiliation
Other Contributors
Publication date
2025/06/17
Subject
Collections
Research Projects
Organizational Units
Journal Issue
Abstract
The role of intestinal mesentery and the extent of its resection as a determinant of outcomes post-bowel resection in Crohn's disease (CD) remains a subject of debate. We evaluated outcomes of conventional mesenteric resection (CMR) and compared it with extended mesenteric resection (EMR) in patients undergoing ileo-colic excision for limited ileo-colonic CD. A comprehensive search was conducted in accordance with PRISMA guidelines using Medline, Embase, PubMed, and Cochrane databases. Comparative studies of patients with limited ileo-colonic CD undergoing CMR and EMR for ileo-colic resection were included. Studies comparing anastomotic techniques, single-arm, case reports/series, study protocols and editorials were excluded. Primary outcomes were disease recurrence and re-operation. Secondary outcomes included post-operative complications, intra-operative blood loss, length of stay, total operative time and re-admission rate. Meta-analysis was performed using Cochrane RevMan Web on outcomes reported by two or more studies. Combined overall effect sizes were calculated using random-effects model and the Newcastle-Ottawa Scale and Cochrane risk-of-bias tools were used to assess bias. Five studies met our inclusion criteria (four retrospective cohort studies; one randomised controlled trial (RCT)) with a total of 4,358 patients (EMR: 993 vs. CMR: 3,365). No statistical difference was observed across any of the analysed outcomes: disease recurrence [OR: 0.49 CI 0.21-1.16, P = 0.10], re-operation [OR: 0.33 CI 0.06-1.65, P = 0.17], intra-operative blood loss [MD: -18.71 CI -76.65-39.23, P = 0.53], anastomotic leak [OR: 0.98 CI 0.34-2.82, P = 0.97], length of stay [MD: -0.06 CI -0.59-0.48, P = 0.83], post-operative morbidity [OR: 1.01 CI 0.82-1.24, P = 0.95], blood transfusion [OR: 1.16 CI 0.84-1.59, P = 0.36], Clavien-Dindo III + complications [OR: 0.83 CI 0.5-1.38, P = 0.47], post-operative ileus [OR: 0.97 CI 0.27-3.50, P = 0.96], intra-abdominal bleeding [OR: 0.85 CI 0.22-3.26, P = 0.81], re-admission [OR: 0.65 CI 0.24-1.78, P = 0.40], surgical site infection [OR: 1.00 CI 0.77-1.30, P = 0.99], post-operative adjuvant or prophylactic therapy [OR: 0.90 CI 0.54-1.51, P = 0.69] and total operative time [MD: 0.38 CI -4.42-5.19, P = 0.88]. Performing EMR during ileo-colic resection for patients with limited ileo-colonic CD does not seem to confer any additional benefit to conventional (limited resection) approaches. Robust, well-designed, large-scale RCTs are needed to better compare these techniques and demonstrate superiority in clinical outcomes
Citation
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 Jun 18;40(1):144. doi: 10.1007/s00384-025-04937-3.