Vaghiri Sascha, Alipouriani Ali, Knoefel Wolfram Trudo, Kessler Hermann, Prassas Dimitrios
Department of Surgery (A), Heinrich-Heine-University, Medical Faculty and University Hospital Duesseldorf, Moorenstr. 5, Bldg. 12.46, 40225, Duesseldorf, Germany.
Department for Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
Int J Colorectal Dis. 2025 Feb 25;40(1):51. doi: 10.1007/s00384-025-04845-6.
Mesenteric resection in Crohn's disease (CD) is still controversial and under discussion. We performed a meta-analysis to assess recurrence rates and operative-related morbidity based on the extent of mesenteric resection.
A comprehensive literature research was conducted until November 2024 using PubMed (Medline), the Cochrane Central trials register, and Google Scholar databases. Studies before the biological era or with Kono-S anastomosis were excluded. Data from comparative studies with reported patient characteristics and outcome results of extended and limited mesenteric resections were extracted and subsequently entered into a pairwise meta-analysis model. Odds ratios (ORs) for dichotomous variables and standardized mean differences (SMDs) for continuous outcomes with 95% confidence intervals (CIs) were calculated. The risk of bias was rated according to ROBINS-I and Rob2 criteria, respectively.
Four non-randomized studies and one randomized trial with a total of 4358 patients (extended mesenteric resection: n = 993 versus mesenteric preservation: n = 3365) met eligibility criteria and were included. Extended mesenteric resection was significantly associated with reduced surgical recurrence rates compared to mesenteric preservation (OR = 4.94; 95% CI [2.22-10.97]; p < 0.001, I = 0%). In terms of endoscopic recurrence, postoperative morbidity, and hospital stay, no significant differences between both groups were noted within the short follow-up period.
Extended mesenteric resection demonstrated a lower surgical recurrence rate in Crohn's disease, while morbidity rates were comparable to the mesenteric sparing approach, whether extended mesenteric excision should be recommended requires further high-quality randomized trials with long-term follow-up data.
克罗恩病（CD）的肠系膜切除术仍存在争议且有待探讨。我们进行了一项荟萃分析，以评估基于肠系膜切除范围的复发率和手术相关发病率。
截至2024年11月，使用PubMed（Medline）、Cochrane中心试验注册库和谷歌学术数据库进行了全面的文献检索。排除生物治疗时代之前或采用Kono-S吻合术的研究。提取了具有报告的患者特征以及扩大和有限肠系膜切除术结果的比较研究数据，随后将其纳入成对荟萃分析模型。计算二分变量的比值比（OR）和连续结果的标准化均值差（SMD），并给出95%置信区间（CI）。分别根据ROBINS-I和Rob2标准对偏倚风险进行评级。
四项非随机研究和一项随机试验，共4358例患者（扩大肠系膜切除术：n = 993例；保留肠系膜：n = 3365例）符合纳入标准并被纳入。与保留肠系膜相比，扩大肠系膜切除术与手术复发率降低显著相关（OR = 4.94；95%CI[2.22 - 10.97]；p < 0.001，I = 0%）。在内镜复发、术后发病率和住院时间方面，两组在短期随访期内未发现显著差异。
扩大肠系膜切除术在克罗恩病中显示出较低的手术复发率，而发病率与保留肠系膜的方法相当，是否应推荐扩大肠系膜切除术需要进一步的高质量随机试验及长期随访数据。
