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Extended versus limited mesenteric excision for operative Crohn’s disease: 30-Day outcomes from the ACS-NSQIP database

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Recent studies have suggested that extended mesenteric excision (ME) may reduce surgical reintervention in Crohn’s Disease (CD), but there remains clinical concerns regarding potential peri-operative morbidity. This retrospective study compares 30-day perioperative morbidity between limited and extended ME in segmental colectomies for CD.

Methods

Using the American College of Surgeons National Surgical Quality Improvement (ACS-NSQIP) colectomy-specific database, all patients with CD undergoing segmental colectomy for non-malignant indications between 2014–2019 were included. A lymph node harvest of 12 or more nodes was used as a surrogate for extended ME. The primary outcome was NSQIP major morbidity. Secondary outcomes included abdominal complications and perioperative bleeding.

Results

Of 3,709 patients included from the ACS-NSQIP database, 3,087 underwent limited ME and 622 underwent extended ME. On univariate analysis, those with limited mesenteric excision were less likely to be anemic (46.1% vs 55.0%, p < 0.001) and have undergone an open surgery (44.7% vs 34.7%, p < 0.001). On univariate comparison of limited and extended ME, there was no significant difference in major morbidity. On multiple logistic regression, controlling for age, sex, BMI, smoking, preoperative sepsis, preoperative anemia, surgical approach, emergency surgery, stoma creation, bowel preparation, and immunosuppression, the extent of ME was not an independent predictor of NSQIP major morbidity (OR 1.1, 95% CI 0.84–1.44). Likewise, the extent of ME was not associated with an increase in abdominal complications (OR 0.95, 95% CI 0.76–1.19) or post-operative bleeding (OR 1.89, 95% CI 0.75–1.53).

Conclusion

Extended ME for CD was not associated with an increase in 30-day perioperative major morbidity.

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Data availability

All data collected in our study are stored in our institutions’ protected firewall and are available upon request.

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Funding

No funding was obtained for this study.

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Authors and Affiliations

  1. Department of Surgery, McGill University, Jewish General Hospital, 3755 Cote Ste Catherine, G-317, Montreal, QC, Canada

    Shafic Abdulkarim, Ebram Salama, Allison J. Pang, Nancy Morin, Gabriela Ghitulescu, Julio Faria, Carol-Ann Vasilevsky & Marylise Boutros

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  1. Shafic Abdulkarim
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  2. Ebram Salama
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  3. Allison J. Pang
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  4. Nancy Morin
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  5. Gabriela Ghitulescu
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  6. Julio Faria
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  7. Carol-Ann Vasilevsky
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  8. Marylise Boutros
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Contributions

All authors contributed to the design of the study. Shafic Abdulkarim, Ebram Salama and Marylise Boutros participated in data acquisition. Shafic Abdulkarim, Ebram Salama, Allison J. Pang, Nancy Morin, Gabriela Ghitulescu, Julio Faria, Carol-Ann Vasilevsky and Marylise Boutros participated in data analysis and interpretation. Shafic Abdulkarim, Ebram Salama and Marylise Boutros prepared the first draft of the manuscript. All authors contributed to, and approved, the final version of the manuscript.

Corresponding author

Correspondence to Shafic Abdulkarim.

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Conflict of interest

Shafic Adbulkarim, Ebram Salama, Allison J. Pang, Gabriela Ghitulescu, Nancy Morin, Julio Faria, Carol-Ann Vasilevsky and Marylise Boutros have no financial or non-financial conflict of interests to disclose.

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Abdulkarim, S., Salama, E., Pang, A.J. et al. Extended versus limited mesenteric excision for operative Crohn’s disease: 30-Day outcomes from the ACS-NSQIP database. Int J Colorectal Dis 38, 268 (2023). https://doi.org/10.1007/s00384-023-04561-z

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  • DOI: https://doi.org/10.1007/s00384-023-04561-z

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