Clinical outcomes of conventional versus extended mesenteric resection in limited ileo-colonic Crohn’s disease: a systematic review and meta-analysis
Bibliographic record
Abstract
BACKGROUND: The role of intestinal mesentery and the extent of its resection as a determinant of outcomes post-bowel resection in Crohn's disease (CD) remains a subject of debate. We evaluated outcomes of conventional mesenteric resection (CMR) and compared it with extended mesenteric resection (EMR) in patients undergoing ileo-colic excision for limited ileo-colonic CD. METHODS: A comprehensive search was conducted in accordance with PRISMA guidelines using Medline, Embase, PubMed, and Cochrane databases. Comparative studies of patients with limited ileo-colonic CD undergoing CMR and EMR for ileo-colic resection were included. Studies comparing anastomotic techniques, single-arm, case reports/series, study protocols and editorials were excluded. Primary outcomes were disease recurrence and re-operation. Secondary outcomes included post-operative complications, intra-operative blood loss, length of stay, total operative time and re-admission rate. Meta-analysis was performed using Cochrane RevMan Web on outcomes reported by two or more studies. Combined overall effect sizes were calculated using random-effects model and the Newcastle-Ottawa Scale and Cochrane risk-of-bias tools were used to assess bias. RESULTS: Five studies met our inclusion criteria (four retrospective cohort studies; one randomised controlled trial (RCT)) with a total of 4,358 patients (EMR: 993 vs. CMR: 3,365). No statistical difference was observed across any of the analysed outcomes: disease recurrence [OR: 0.49 CI 0.21-1.16, P = 0.10], re-operation [OR: 0.33 CI 0.06-1.65, P = 0.17], intra-operative blood loss [MD: -18.71 CI -76.65-39.23, P = 0.53], anastomotic leak [OR: 0.98 CI 0.34-2.82, P = 0.97], length of stay [MD: -0.06 CI -0.59-0.48, P = 0.83], post-operative morbidity [OR: 1.01 CI 0.82-1.24, P = 0.95], blood transfusion [OR: 1.16 CI 0.84-1.59, P = 0.36], Clavien-Dindo III + complications [OR: 0.83 CI 0.5-1.38, P = 0.47], post-operative ileus [OR: 0.97 CI 0.27-3.50, P = 0.96], intra-abdominal bleeding [OR: 0.85 CI 0.22-3.26, P = 0.81], re-admission [OR: 0.65 CI 0.24-1.78, P = 0.40], surgical site infection [OR: 1.00 CI 0.77-1.30, P = 0.99], post-operative adjuvant or prophylactic therapy [OR: 0.90 CI 0.54-1.51, P = 0.69] and total operative time [MD: 0.38 CI -4.42-5.19, P = 0.88]. CONCLUSION: Performing EMR during ileo-colic resection for patients with limited ileo-colonic CD does not seem to confer any additional benefit to conventional (limited resection) approaches. Robust, well-designed, large-scale RCTs are needed to better compare these techniques and demonstrate superiority in clinical outcomes.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.004 | 0.006 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".