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- Title
EFFECTIVENESS OF EXTENDED MESENTERIC EXCISION IN PREVENTING POSTOPERATIVE CROHN'S DISEASE RECURRENCE: SYSTEMATIC REVIEW AND META-ANALYSIS.
- Authors
Topala, Mihaela; Martinekova, Petrana; Rancz, Anett; Kói, Tamás; Lászlóné Lenti, Katalin Földvári-Nagy; Miheller, Pál; Erőss, Bálint; Hegyi, Péter; Ábrahám, Szabolcs
- Abstract
Introduction. Crohn's disease (CD) is characterized by recurrent flares of intestinal inflammation that can determine intra-abdominal complications. Frequently, patients require surgery and almost 25% will need multiple interventions. The mesentery might be involved in CD pathogenesis by modulating local hormonal and immunologic processes and surgical techniques involving the mesentery have recently drawn attention. We aimed to review the literature and to investigate whether removing the mesentery during intestinal resection might influence the postoperative outcome. Objective. We evaluated the effectiveness of performing extended mesenteric excision (EME) in preventing postoperative CD recurrence (POR) compared with limited mesenteric excision (LME). We also investigated the role of EME on overall postoperative complications (POC) compared to LME. Materials and Methods. Studies reporting shortand long-term outcomes of CD patients who underwent intestinal resection with EME compared with LME were considered eligible. A systematic search was performed in Pubmed, Embase, Cochrane, Scopus and Web of Science from inception until 9th November 2022. Pooled odds ratios (ORs) with a 95% confidence interval (CI) were calculated using the random-effects model. The risk of bias was assessed with the ROBINS-I tool. We evaluated the certainty of evidence according to the recommendations proposed by the GRADE Working Group. Results. 7201 records were retrieved. After duplicate removal and selection process, we included six papers that reported data from five studies. The meta-analysis comprised data pooled from three retrospective cohort studies, of which two included patients with ileocolic resections and one with colorectal resections. These studies analyzed 516 patients, of which 304 underwent EME and 212 LME. Our results showed a non-significant lower rate of surgical recurrence in the EME group compared with LME (OR 0.3; 95%CI:0.02-3.73). Regarding overall POC, EME was also associated with non-significant lower odds (OR 0.78; 95%CI:0.33-1.82). The certainty of the evidence was very low and low, respectively due to the moderate level of bias and, more importantly, by the inconsistency and imprecision of the results. Conclusion. Our meta-analysis indicated a trend towards lower rates of POR in patients who underwent intestinal resections with EME compared with LME. However, results should be interpreted cautiously due to statistical non-significance and low quality of evidence. Considering overall POC, performing intestinal resections with EME appears to be a safe procedure compared with LME. Results from ongoing randomized controlled trials and further studies are needed to determine the role of mesentery resections in CD surgery.
- Subjects
LONDON Metal Exchange Ltd.; CROHN'S disease; DISEASE relapse; INFLAMMATORY bowel diseases; RANDOMIZED controlled trials; MESENTERY
- Publication
Journal of Gastrointestinal & Liver Diseases, 2023, Vol 32, p76
- ISSN
1841-8724
- Publication type
Article