Resection of the mesentery vs Kono-S anastomosis in preventing surgical recurrence for primary Crohn disease: the REMEASURE prospective, randomized, controlled trial.

内容摘要

Many authors have investigated whether a new functional end-to-end anastomosis, the Kono-S, or the resection of the mesentery could allow better results following primary ileocolic-resection for Crohn Disease. The Resection of the mesentery vs Kono-S anastomosis in preventing surgical recurrence (Remeasure)-trial aims at investigating if Kono-S-anastomosis or resection of the mesentery with functional end-to-end anastomosis could impact results in terms of postoperative complications and surgical, endoscopic and clinical recurrence. Randomized prospective trial at a tertiary referral Institution. Primary endpoint: endoscopic recurrence at 6 months (Rutgeerts score i2 or greater). Secondary endpoints: postoperative complications, clinical recurrence after 12 months, endoscopic-recurrence after 18 months, surgical recurrence after 24 months. 73 patients randomly assigned: 36 to Kono-S and 37 to mesenteric-resection. The two groups had similar peri-operative course. Surgical-recurrence occurred in two patients (1 following Kono-S, 1 following mesentery-resection). Six-months endoscopic-recurrence occurred in 12/36 (33%) of Kono-S patients and in 12/37 (32%) of the mesenteric-resection group. The 6-12- and 18-month time-to-event estimates showed no significant differences in endoscopic or clinical recurrence. In the Cox proportional hazards model, perforating behavior was a risk factor for late endoscopic recurrence (HR 1.70, p = 0.05), whereas adjuvant biologic therapy was protective (HR 1.32, p = 0.034). The Remeasure trial doesn't show significant advantages in terms of postoperative complications, surgical, endoscopic and clinical recurrence after Kono-S anastomosis or mesenteric-resection technique following primary ileocolic-resection in Crohn Disease.