Adipocyte-Epithelial Interactions and Crohn's Disease - An Emerging Drug Target

Coffey, Calvin; Kiernan, Miranda G.

doi:10.1016/j.ebiom.2017.08.029

Cited by 3 publications

(3 citation statements)

References 9 publications

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“…Increasing data suggest that the mesentery is involved in CD (10)(11)(12). Mesenteric adipose tissue and alterations in mesenteric lymphatics correlate with disease progression of CD.…”

Section: Introductionmentioning

confidence: 99%

Role of Extended Mesenteric Excision in Postoperative Recurrence of Crohn's Colitis: A Single-Center Study

Zhu

Qian

Huang

et al. 2021

Clin Transl Gastroenterol

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INTRODUCTION: The mesentery is involved in Crohn's disease. The impact of the extent of mesenteric resection on postoperative disease progression in Crohn's disease remains unconfirmed. This study aimed to determine the association between resection of the mesentery and postoperative outcomes in patients with Crohn's colitis (CC) undergoing colorectal surgery. METHODS: Patients with CC who underwent colorectal resection between January 2000 and December 2018 were reviewed, and the data were gathered from a prospectively maintained database. Patients were divided into 2 groups according to the extent of mesenteric resection, the extensive mesenteric excision (EME) group and the limited mesenteric excision (LME) group. Outcomes including early postoperative morbidities and surgical recurrence were compared between the 2 groups. RESULTS: Of the 126 patients included, 60 were in the LME group and 66 in the EME group. There was no significant difference between the 2 groups in early postsurgical outcomes except the intraoperative blood loss was increased in the LME group (P = 0.002). Patients in the EME group had a longer postoperative surgical recurrence-free survival time when compared with those in the LME group (P = 0.01). LME was an independent predictor of postoperative surgical recurrence (hazard ratio 2.67, 95% confidence interval 1.04–6.85, P = 0.04). This was further confirmed in the subgroup analysis of patients undergoing colorectal resection and anastomosis (hazard ratio 2.83, 95% confidence interval 1.01–7.96, P = 0.048). DISCUSSION: In patients undergoing surgery for CC, inclusion of the mesentery is associated with similar short-term outcomes and improved long-term outcomes compared with those seen when the mesentery is retained.

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“…Increasing data suggest that the mesentery is involved in CD (10)(11)(12). Mesenteric adipose tissue and alterations in mesenteric lymphatics correlate with disease progression of CD.…”

Section: Introductionmentioning

confidence: 99%

Role of Extended Mesenteric Excision in Postoperative Recurrence of Crohn's Colitis: A Single-Center Study

Zhu

Qian

Huang

et al. 2021

Clin Transl Gastroenterol

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“…Studies have reported that the severity of mesenteric inflammation is closely related to the subsequent recurrence probability and can be used as a predicator of disease prognosis 128–131 . The mesenteric thickness tightly and topographically correlates with the area of intestinal inflammation 132–134 . Advanced mesenteric diseases (i.e., fat wrapping) could be regarded as a basis for assessing the need to remove intestinal segments and fat wrapping greater than 50%, which are associated with increased surgical recurrence 135 …”

Section: Advances In Operative Proceduresmentioning

confidence: 99%

“… 128 , 129 , 130 , 131 The mesenteric thickness tightly and topographically correlates with the area of intestinal inflammation. 132 , 133 , 134 Advanced mesenteric diseases (i.e., fat wrapping) could be regarded as a basis for assessing the need to remove intestinal segments and fat wrapping greater than 50%, which are associated with increased surgical recurrence. 135 …”

Section: Advances In Operative Proceduresmentioning

confidence: 99%

Perioperative optimization of Crohn's disease

Lin

Chen

et al. 2022

Annals of Gastroent Surgery

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Crohn's disease (CD) is a chronic inflammatory disease mainly affecting the gastrointestinal tract. With the increased availability of modalities in the last two decades, the treatment of CD has advanced remarkably. Although medical treatment is the mainstay of therapy, most patients require surgery during the course of their illness, especially those who experience complications. Nutritional optimization and ERAS implementation are crucial for patients with CD who require surgical intervention to reduce postoperative complications. The increased surgical risk was found to be associated with the use of corticosteroids, but the association of surgical risk with immunomodulators, biologic therapy, such as anti‐TNF mediations, anti‐integrin medications, and anti‐IL 12/23 was low in certainty. Decisions about preoperative medication must be made on an individual case‐dependent basis. Preoperative imaging studies can assist in the planning of appropriate surgical strategies and approaches. However, patients must be informed of any alterations to their treatment. In summary, the management of perioperative medications and surgery‐related decision‐making should be individualized and patient‐centered based on a multidisciplinary approach.

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Mesenteric excision surgery or conservative limited resection in Crohn’s disease: study protocol for an international, multicenter, randomized controlled trial

Mohan

et al. 2020

Trials

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Background: The structures of the mesentery including adipose tissue, nerves, and lymphatics play an important role in the pathogenesis and disease progression of Crohn's disease (CD). Conventional surgical resection for CD usually does not involve resecting the mesentery en bloc with the specimen. This contrasts with complete mesocolic excision (CME) in colorectal cancer, which involves radical resection of the mesentery. Preliminary evidence from smaller studies suggests that applying the principle of mesocolic excision to CD surgery may reduce the risk of postoperative recurrence. This randomized controlled trial is designed to test whether applying the principles of mesocolic excision to CD results in reduced postoperative recurrence. It also aims to evaluate intra-and postoperative morbidity between the two approaches.Methods: This international, multicenter, randomized controlled trial will randomize patients (n = 116) scheduled to undergo primary ileocolic resection to either receive extensive mesenteric excision (EME) or conventional ileocolic resection with limited mesenteric excision (LME). Five sites will recruit patients in three countries. In the EME group, the mesentery is resected following CME, while avoiding the root region, i.e., 1 cm from the root of the ileocolic artery and vein. In the LME group, the mesentery is retained, i.e., "close shave" or < 3 cm from the border of bowel. The primary end point will be surgical recurrence after surgery. The secondary end points will be the postoperative endoscopic and clinical recurrence, and intra-and postoperative morbidity. Demographics, risk factors, laboratory investigations, endoscopy, postoperative prophylaxis and imaging examination will be assessed. Analysis of the primary outcome will be on an intention-to-treat basis.Discussion: If mesocolic excision in CD reduces postoperative disease recurrence and does not increase morbidity, this trial has the potential to change practice and reduce recurrence of CD after surgical resection.

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Adipocyte-Epithelial Interactions and Crohn's Disease - An Emerging Drug Target

Cited by 3 publications

References 9 publications

Role of Extended Mesenteric Excision in Postoperative Recurrence of Crohn's Colitis: A Single-Center Study

Role of Extended Mesenteric Excision in Postoperative Recurrence of Crohn's Colitis: A Single-Center Study

Perioperative optimization of Crohn's disease

Mesenteric excision surgery or conservative limited resection in Crohn’s disease: study protocol for an international, multicenter, randomized controlled trial

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