Department of Surgery, University Hospital Limerick, Limerick, Ireland.
Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
J Crohns Colitis. 2018 Nov 9;12(10):1139-1150. doi: 10.1093/ecco-jcc/jjx187.
Inclusion of the mesentery during resection for colorectal cancer is associated with improved outcomes but has yet to be evaluated in Crohn's disease. This study aimed to determine the rate of surgical recurrence after inclusion of mesentery during ileocolic resection for Crohn's disease.
Surgical recurrence rates were compared between two cohorts. Cohort A [n = 30] underwent conventional ileocolic resection where the mesentery was divided flush with the intestine. Cohort B [n = 34] underwent resection which included excision of the mesentery. The relationship between mesenteric disease severity and surgical recurrence was determined in a separate cohort [n = 94]. A mesenteric disease activity index was developed to quantify disease severity. This was correlated with the Crohn's disease activity index and the fibrocyte percentage in circulating white cells.
Cumulative reoperation rates were 40% and 2.9% in cohorts A and B [P = 0.003], respectively. Surgical technique was an independent determinant of outcome [P = 0.007]. Length of resected intestine was shorter in cohort B, whilst lymph node yield was higher [12.25 ± 13 versus 2.4 ± 2.9, P = 0.002]. Advanced mesenteric disease predicted increased surgical recurrence [Hazard Ratio 4.7, 95% Confidence Interval: 1.71-13.01, P = 0.003]. The mesenteric disease activity index correlated with the mucosal disease activity index [r = 0.76, p < 0.0001] and the Crohn's disease activity index [r = 0.70, p < 0.0001]. The mesenteric disease activity index was significantly worse in smokers and correlated with increases in circulating fibrocytes.
Inclusion of mesentery in ileocolic resection for Crohn's disease is associated with reduced recurrence requiring reoperation.
结直肠切除术中纳入肠系膜可改善预后，但在克罗恩病中尚未得到评估。本研究旨在确定在克罗恩病行回肠结肠切除术中纳入肠系膜后手术复发的发生率。
比较了两组手术复发率。队列 A [n=30]行常规回肠结肠切除术，其中肠系膜与肠壁平齐切开。队列 B [n=34]行包括肠系膜切除的切除术。在另一组 [n=94]中，确定肠系膜疾病严重程度与手术复发之间的关系。开发了肠系膜疾病活动指数来量化疾病严重程度。将其与克罗恩病活动指数和循环白细胞中纤维母细胞的百分比相关联。
队列 A 和 B 的累积再手术率分别为 40%和 2.9%[P=0.003]。手术技术是独立的预后决定因素[P=0.007]。队列 B 切除的肠段较短，而淋巴结产量较高[12.25±13与 2.4±2.9，P=0.002]。高级肠系膜疾病预测手术复发增加[风险比 4.7，95%置信区间：1.71-13.01，P=0.003]。肠系膜疾病活动指数与黏膜疾病活动指数相关[r=0.76，p<0.0001]和克罗恩病活动指数相关[r=0.70，p<0.0001]。吸烟者的肠系膜疾病活动指数更差，与循环纤维母细胞的增加相关。
克罗恩病回肠结肠切除术中纳入肠系膜与减少需要再次手术的复发有关。
