OP19 Extended mesenterectomy is not superior to mesenteric sparing resection in primary ileocolic resection for Crohn’s Disease in terms of postoperative endoscopic recurrence – results of an international randomised controlled trial

Abstract

Abstract Background Extended mesenteric resection has recently been proposed to improve clinical outcomes after an ileocolic resection (ICR) for Crohn’s disease. The aim of this study was to analyse the clinical relevance of extended mesenteric resection, up to the level of the ileocolic trunk (intervention group), compared to conventional mesenteric sparing resection (control group) with regard to postoperative outcomes in patients undergoing primary ICR for Crohn’s disease. Methods In an international randomised controlled trial (RCT), patients ≥16 years, were assigned 1:1 to either the intervention- or the control-group. The anastomotic technique was standardised (side-to-side stapled). To demonstrate a relevant difference of 25% in postoperative endoscopic recurrence (defined as a modified Rutgeerts score ≥i2b, according to central reading) at 6 months, a minimum of 62 evaluable patients per arm were required. Secondary outcome parameters were postoperative morbidity, histopathological outcomes and use of Crohn’s medication postoperatively. Results In total, of the 129 included patients, 56 (43.3%) were male with a median age of 36 (IQR 22-55). There were no statistically significant differences in baseline characteristics between the two groups. There was no difference in endoscopic recurrence rates between the two groups: 27/62 (43.5%) in the intervention group and 27/64 (42.2%) in the control group, (p=1.0) Fig 1. Median time until endoscopy was 6 months (IQR 6-7). More patients received postoperative medical prophylaxis in the intervention group (28% vs 14%). In the control group, more patients started medication after endoscopy (intervention group 20% vs control group 27%). This resulted in a similar number of patients in both groups being on Crohn’s medication after six months, 48% in the intervention group and 41% in the control group. There was no significant difference in length of resection specimen (median length colon 7cm; ileum 22.5cm), blood-loss or operative time. Overall, a postoperative complication occurred in 28%, with anastomotic leakage in 5 (3.9%). Conclusion This is the first RCT to present data on the effect of extended mesenteric resection during ICR for Crohn’s disease. The results of this study showed no superiority of extended mesenteric resection with regard to endoscopic recurrence or other perioperative outcomes.