Does the extended mesenteric resection really reduce the surgical recurrences in Crohn's disease?

Abstract

Crohn’s disease is notorious for the high rate of recurrences after surgery, some of which require repeated operative interventions. The extended mesenteric excision can be considered as an additional, “surgical” attempt to diminish the rate of surgical recurrences, similar to the other approaches, such as the type of anastomosis (Kono-S and functional end-to-end) and achievement of clear resection margins.

We want to focus the reader’s attention on two contradictory meta-analyses published within four months in Int J Colorectal Dis this year - “Extended mesenteric resection reduces the rate of surgical recurrence in Crohn’s disease: a systematic review and meta-analysis” (Vaghiri et al.) and „Clinical outcomes of conventional versus extended mesenteric resection in limited ileo-colonic Crohn's disease: a systematic review and meta-analysis“ (Mostafa et al.), which failed to demonstrate benefit from the extended resection. We congratulate the authors for the good work, but we also have particular concerns regarding the results, which should be interpreted with caution. From our perspective, there is a lack of sound evidence, and the role of extended resection remains unclear, making the title of the first meta-analysis somewhat misleading.

The observed phenomenon illustrates how even meta-analyses can be misleading, underscoring the importance of cautious interpretation of the published literature. The correct selection of studies and calculation of a sufficient sample size (number of patients and events) is of paramount importance to avoid the random error, which in the “early” meta-analyses frequently leads to overestimation of the effect of interventions.