Extended Mesenteric Resection in Ileocecal Crohn's Disease.
- Conditions
- Crohn's Disease of Terminal Ileum
- Interventions
- Procedure: Extended laparoscopic ileocecal resectionProcedure: Standard laparoscopic ileocecal resection
- Registration Number
- NCT06324838
- Lead Sponsor
- Odense University Hospital
- Brief Summary
The EXCEED project aims to study the role of the mesentery in disease recurrence in Crohn's disease (CD), as evidence suggests that including the mesentery when doing ileocecal resections can significantly reduce recurrence rates. The EXCEED study is a blinded randomised clinical trial with 204 participants having ileocecal Crohn's disease requiring resection. Participants will undergo either "standard" mesocolic sparing resection or extended mesocolic resection to assess its impact on reducing recurrence at the anastomotic site. The primary endpoint is endoscopic recurrence 12 months postoperatively.
Additionally, the study aims to evaluate the efficacy of different surveillance modalities in detecting anastomotic site recurrence. These examinations will be conducted pre- and postoperatively for a cohort of 20 participants.
Through this study, we seek to understand the mesentery's role in Crohn's disease recurrence and identify effective non-invasive methods for postoperative monitoring.
- Detailed Description
Surgical Procedure and Perioperative Care Laparoscopic approach with a minimum 5 cm disease-free bowel on each side. Standard stapled side-to-side isoperistaltic anastomoses. Extended mesenteric excision involves resection of inflamed mesentery up to the level of visible inflammation.
Both treatment groups will receive standard postoperative care according to the standards of the hospital treating the participant.
Postoperative Follow-up Postoperative follow-up at 6 and 12 months. This consist of an ileo-colonoscopy, chart review and questionnaires. The early follow-up at 6 months aims to detect early recurrence, enabling early medical treatment or other intervention. The 12-month follow-up will be the primary endpoint to determine recurrence. Long-term outcomes will be assessed through a chart review after 3 and 5 years, documenting reoperations, clinical symptoms, pharmacological use, and other complications.
Postoperative Medicinal Use Postoperative medical prophylaxis assessment isn't explicitly detailed in the current protocol, though it will be acknowledged. Analysis will stratify participants based on pre- and post-operative biological/non-biological treatment. The treating physician will determine postoperative medical therapy, typically maintaining pre-operative medication.
Postoperative Endoscopy Endoscopy will be regarded as the golden standard for the detection of disease recurrence. The endoscopies, including bowel preparation and possible sedation, will be preformed in accordance with local guidelines at each hospital. At least three biopsies will be taken from the ileum (5 cm proximal to the anastomosis), anastomosis, and colon (5 cm below the anastomosis). A short video of each endoscopy will be saved for validation purposes. Lesions found during the endoscopy will be classified using the modified Rutgeerts score\[7\].
Patient-Reported Outcome During the preoperative workup (baseline), the participant will be asked to complete 2 questionnaires (5Q-5D-5L and SIBDQ). Postoperatively, the participant will be asked to complete the same questionnaires at 6 and 12 months.
Statistical analysis plan Outcome Analysis The investigators plan to conduct a chi-square or Fisher's exact test to compare the proportion of participants with endoscopic recurrence between the intervention and control groups.
The investigators will utilize logistic regression to adjust for potential confounding variables if needed.
Demographics The Investigators will use means and standard deviations (or medians and interquartile ranges) for continuous variables. For categorical variables, frequencies and percentages will be presented and demographic characteristics between intervention and control groups will be compared.
Recruitment & Eligibility
- Status
- NOT_YET_RECRUITING
- Sex
- All
- Target Recruitment
- 204
Not provided
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Extended mesenteric resection Extended laparoscopic ileocecal resection Arm receiving ileocecal resection with extended mesenteric resection. Controls (Standard mesenteric resection) Standard laparoscopic ileocecal resection Arm receiving standard ileocecal resection.
- Primary Outcome Measures
Name Time Method Endoscopic recurrence 12 months postoperative Endoscopic signs of recurrence, defined as a modified Rutgeerts score \>i2a.
- Secondary Outcome Measures
Name Time Method Clinical signs of recurrence / morbidity. 6-48 months postoperatively Resumption of medicinal treatment. Chart review will be done to identify postoperative medicinal use.
Perioperative complications 30 days postoperative Postoperative complications according to Clavien-Dindo classification.
Early endoscopic recurrence 6 months postoperative Endoscopic signs of recurrence, defined as a modified Rutgeerts score \>i2a.
Patient reported outcome 1 6 and 12 months postoperative 5Q-5D-5L
Cost of treatment 12 months postoperative. Difference in treatment cost between the two groups. Reported in USD.
Difference in disease severity Perioperative At the time of operation according to the Montreal classification.
Reoperations 6 and 12 months postoperative Chart review will be done to identify any reoperations due to recurrence or other complications.
Patient reported outcome 2 6 and 12 months postoperative SIBDQ