• Calvin J Coffey, Miranda G Kiernan, Shaheel M Sahebally, Awad Jarrar, John P Burke, Patrick A Kiely, Bo Shen, David Waldron, Colin Peirce, Manus Moloney, Maeve Skelly, Paul Tibbitts, Hena Hidayat, Peter N Faul, Vourneen Healy, Peter D O'Leary, Leon G Walsh, Peter Dockery, Ronan P O'Connell, Sean T Martin, Fergus Shanahan, Claudio Fiocchi, and Colum P Dunne.
• Department of Surgery, University Hospital Limerick, Limerick, Ireland.
• J Crohns Colitis. 2018 Nov 9; 12 (10): 1139-1150.

Background And AimsInclusion 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.MethodsSurgical 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.ResultsCumulative 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.ConclusionsInclusion of mesentery in ileocolic resection for Crohn's disease is associated with reduced recurrence requiring reoperation.

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