Mineccia Michela, Maconi Giovanni, Daperno Marco, Cigognini Maria, Cherubini Valeria, Colombo Francesco, Perotti Serena, Baldi Caterina, Massucco Paolo, Ardizzone Sandro, Ferrero Alessandro, Sampietro Gianluca M
Division of General and Oncologic Surgery, Ospedale Mauriziano Umberto I, Largo Turati 62, 10128 Torino, Italy.
Division of Gastroenterology, ASST Fatebenefratelli-Sacco, via G.B. Grassi 74, 20157 Milano, Italy.
J Clin Med. 2022 Apr 1;11(7):1961. doi: 10.3390/jcm11071961.
Some evidence suggests a reduction in clinical and surgical recurrence after mesenteric resection in Crohn's Disease (CD). The aim of the REsection of the MEsentery StuDY (Remedy) was to assess whether mesenteric removal during surgery for ileocolic CD has an impact in terms of postoperative complications, endoscopic and ultrasonographic recurrences, and long-term surgical recurrence. Among the 326 patients undergoing primary resection between 2009 and 2019 in two referral centers, in 204 (62%) the mesentery was resected (Group A) and in 122 (38%) it was retained (Group B). Median follow-up was 4.7 ± 3 years. Groups were similar in the peri-operative course. Endoscopic and ultrasonographic recurrences were 44.6% and 40.4% in Group A, and 46.7% and 41.2% in Group B, respectively, without statistically significant differences. The five-year time-to-event estimates, compared with the Log-rank test, were 3% and 4% for normal or thickened mesentery ( = 0.6), 2.8% and 4% for resection or sparing of the mesentery ( = 0.6), and 1.7% and 5.4% in patients treated with biological or immunosuppressants versus other adjuvant therapy ( = 0.02). In Cox's model, perforating behavior was a risk factor, and biological or immunosuppressant adjuvant therapy protective for surgical recurrence. The resection of the mesentery does not seem to reduce endoscopic and ultrasonographic recurrences, and the five-year recurrence rate.
一些证据表明，克罗恩病（CD）患者行肠系膜切除术后临床及手术复发率有所降低。肠系膜切除术研究（Remedy）的目的是评估回结肠型CD手术中切除肠系膜对术后并发症、内镜及超声复发以及长期手术复发的影响。在2009年至2019年间，两个转诊中心的326例接受初次切除的患者中，204例（62%）切除了肠系膜（A组），122例（38%）保留了肠系膜（B组）。中位随访时间为4.7±3年。两组围手术期过程相似。A组内镜及超声复发率分别为44.6%和40.4%，B组分别为46.7%和41.2%，差异无统计学意义。与对数秩检验相比，正常或增厚肠系膜的五年事件发生时间估计值分别为3%和4%（P=0.6），肠系膜切除或保留的估计值分别为2.8%和4%（P=0.6），接受生物制剂或免疫抑制剂治疗的患者与接受其他辅助治疗的患者相比分别为1.7%和5.4%（P=0.02）。在Cox模型中，穿透性病变是手术复发的危险因素，生物制剂或免疫抑制剂辅助治疗对手术复发有保护作用。切除肠系膜似乎并未降低内镜及超声复发率以及五年复发率。
