Imperatore, Nicola (2021) Surgical Prevention of anastomotic Recurrence by Excluding Mesentery in Crohn's Disease: the SuPREMe-CD Study. [Tesi di dottorato]
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| Item Type: | Tesi di dottorato |
|---|---|
| Resource language: | English |
| Title: | Surgical Prevention of anastomotic Recurrence by Excluding Mesentery in Crohn's Disease: the SuPREMe-CD Study |
| Creators: | Creators Email Imperatore, Nicola nicola.imperatore@alice.it |
| Date: | 10 December 2021 |
| Number of Pages: | 37 |
| Institution: | Università degli Studi di Napoli Federico II |
| Department: | Medicina Clinica e Chirurgia |
| Dottorato: | Terapie avanzate biomediche e chirurgiche |
| Ciclo di dottorato: | 34 |
| Coordinatore del Corso di dottorato: | nome email Di Minno, Giovanni giovanni.diminno@unina.it |
| Tutor: | nome email Castiglione, Fabiana UNSPECIFIED |
| Date: | 10 December 2021 |
| Number of Pages: | 37 |
| Keywords: | Crohn's disease; post-operative recurrence; Kono-S anastomosis |
| Settori scientifico-disciplinari del MIUR: | Area 06 - Scienze mediche > MED/12 - Gastroenterologia |
| Date Deposited: | 21 Dec 2021 13:33 |
| Last Modified: | 28 Feb 2024 11:40 |
| URI: | http://www.fedoa.unina.it/id/eprint/14313 |
Collection description
BACKGROUND AND AIM: Recently, a new antimesenteric, functional end-to-end, hand-sewn ileocolic anastomosis (Kono-S) has shown a significant reduction in endoscopic recurrence score and surgical recurrence rate in Crohn's disease (CD). This trial aimed to provide randomized controlled data comparing Kono-S anastomosis and stapled ileocolic side-to-side anastomosis. METHODS: Randomized controlled trial at a tertiary referral institution. Primary endpoint: endoscopic recurrence (ER) (Rutgeerts score≥i2) after 6 months. Secondary endpoints: clinical recurrence (CR) after 12 and 24 months, ER after 18 months and surgical recurrence (SR) after 24 months. RESULTS: 79 ileocolic CD patients were randomized in Kono group (36) and Conventional group (43). After 6 months, 22.2% in the Kono group and 62.8% in the Conventional group presented an ER (p < 0.001; OR 5.91). A severe postoperative ER (Rutgeerts score≥i3) was found in 13.8% of Kono vs 34.8% of Conventional group (p=0.03; OR 3.32). CR rate was 8% in the Kono group vs 18% in the Conventional group after 12 months (p=0.2) and 18% vs 30.2% after 24 months (p=0.04, OR 3.47). SR rate after 24 months was 0% in the Kono group vs 4.6% in the Conventional group (p=0.3). Patients with Kono-S anastomosis presented a longer time until CR than patients with side-to-side anastomosis (HR 0.36, p=0.037). On binary logistic regression analysis, the Kono-S anastomosis was the only variable significantly associated with a reduced risk of ER (OR 0.19, p<0.001). There were no differences in postoperative outcomes. CONCLUSIONS: This is the first RCT comparing Kono-S anastomosis and standard anastomosis in CD. The results demonstrate a significant reduction in postoperative endoscopic and clinical recurrence rate for patients who underwent Kono-S anastomosis, and no safety issues. ClinicalTrials.gov ID NCT02631967.
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