Retention of the ileocolic pedicle correlates with higher postoperative endoscopic recurrence risk in Crohn's disease ileocolic resection.

BACKGROUND AND AIMS: The role of residual mesentery after ileocolic resection in Crohn's disease (CD) remains controversial. We conducted a multicenter retrospective study to evaluate the association between postoperative residual ileocolic artery length (RIAL), a surrogate marker of residual mesenteric burden, and endoscopic recurrence (ER) in CD.

METHODS

This multicenter retrospective study involved patients with CD who underwent ileocolic resection between January 2019 and December 2024. RIAL was measured using postoperative contrast-enhanced computed tomography. The primary outcome was ER at the first endoscopic assessment. Least absolute shrinkage and selection operator (LASSO) logistic regression was used to identify predictors of ER and to construct a nomogram. Kaplan-Meier and Cox regression analyses were applied to evaluate ER outcome within 36 months after surgery.

RESULTS

Among 270 patients, 90 (33.3%) developed ER at the first postoperative endoscopy. LASSO logistic regression and the derived nomogram identified that a longer RIAL was associated with an increased risk of ER. ROC curve analysis identified 32.8 mm as the optimal cutoff of RIAL for predicting ER. Kaplan-Meier curve showed that patients with a RIAL < 32.8 mm had significantly longer ER-free survival (log-rank P < .001). Cox analysis identified an RIAL < 32.8 mm and the postoperative use of biologics were independent protective factors for ER-free survival.

CONCLUSIONS

Postoperative ER risk was positively correlated with RIAL in CD. Though these correlative data reveal at a statistical association between ileocolic pedicle division and reduced ER risk, our observational analysis does not prove a causal protective effect of pedicle resection.