Anti-TNF and Postoperative Complications in Abdominal Crohn's Disease Surgery

2019 ◽  
Vol 20 (13) ◽  
pp. 1339-1348 ◽  
Author(s):  
Takayuki Yamamoto ◽  
Fabio Vieira Teixeira ◽  
Rogerio Saad-Hossne ◽  
Paulo Gustavo Kotze ◽  
Silvio Danese
Keyword(s):  
Crohn’S Disease ◽  
Postoperative Complications ◽  
Crohn's Disease ◽  
Abdominal Surgery ◽  
Small Sample Size ◽  
Infectious Complications ◽  
Small Sample ◽  
Increased Risk ◽  
Tnf Α ◽  
Meta Analyses

Background: : Biological therapy with anti-Tumour Necrosis Factor (TNF)-α agents revolutionised the treatment of inflammatory bowel disease over the last decades. However, there may be an increased risk of postoperative complications in Crohn’s disease (CD) patients treated with anti-TNF-α agents prior to abdominal surgery. Objective:: To evaluate the effects of preoperative anti-TNF-α therapy on the incidence of complications after surgery. Methods: : A critical assessment of the results of clinical trial outcomes and meta-analyses on the available data was conducted. Results: : Based on the outcomes of previous reports including meta-analyses, preoperative use of anti- TNF-α agents modestly increased the risk of overall complications and particularly infectious complications after abdominal surgery for CD. Nevertheless, previous studies have several limitations. The majority of them were retrospective research with heterogeneous outcome measures and single centre trials with relatively small sample size. In retrospective studies, the standard protocol for assessing various types of postoperative complications was not used. The most serious limitation of the previous studies was that multiple confounding factors such as malnutrition, use of corticosteroids, and preoperative sepsis were not taken into consideration. Conclusion:: Among patients treated with preoperative anti-TNF-α therapy, the risk of overall complications and infectious complications may slightly increase after abdominal surgery for CD. Nevertheless, the previous reports reviewed in this study suffered from limitations. To rigorously evaluate the risk of anti-TNF-α therapy prior to surgery, large prospective studies with standardised criteria for assessing surgical complications and with proper adjustment for confounding variables are warranted.

The Impact of Anti-Tumor Necrosis Factor Alpha Therapy on Postoperative Complications in Pediatric Crohn's Disease

2019 ◽  
Vol 30 (01) ◽  
pp. 027-032
Author(s):  
Vojtech Dotlacil ◽  
Jiri Bronsky ◽  
Ondrej Hradsky ◽  
Barbora Frybova ◽  
Stepan Coufal ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Postoperative Complications ◽  
Tumor Necrosis Factor ◽  
Crohn's Disease ◽  
Abdominal Surgery ◽  
Tumor Necrosis ◽  
Tnf Α ◽  
Significant Difference ◽  
The Impact ◽  
Necrosis Factor

Abstract Introduction The incidence of Crohn's disease (CD) within the pediatric population is increasing worldwide. Despite a growing number of these patients receiving anti-tumor necrosis factor α therapy (anti-TNF-α), one-third of them still require surgery. There is limited data as to whether anti-TNF-α influences postoperative complications. We evaluated postoperative complications in patients who were or were not exposed to anti-TNF-α therapy in our institutional cohort. Materials and Methods A retrospective review of CD patients who underwent abdominal surgery between September 2013 and September 2018 was performed. The patients were divided into two groups based on whether they were treated with anti-TNF-α within 90 days before surgery. Thirty-day postoperative complications were assessed using Clavien–Dindo classification (D-C); this examination included surgical site infections (SSIs), stoma complications, intra-abdominal septic complications, non-SSIs, bleeding, ileus, readmission rate, and return to the operating room. Mann–Whitney U-test, Fisher's exact test, and multivariate logistic regression analyses were used for statistical analysis. Results Sixty-five patients (41 males) with a median age of 16 years (range: 7–19) at the time of operation were identified. The most common surgery was ileocecal resection in 49 (75%) patients. Forty-three (66.2%) patients were treated with anti-TNF-α preoperatively. Seven patients (11%) experienced postoperative complications. There was no statistically significant difference in postoperative complication in patients who did or did not receive anti-TNF-α before surgery (D-C minor 2.3% vs. 4.6%, p = 1; D-C major 7% vs. 9.1%, p = 1). Conclusion The use of anti-TNF-α in pediatric CD patients within the 90 days prior to their abdominal surgery was not associated with an increased risk of 30-day postoperative complications.

The Influence of Preoperative Medications on Postoperative Complications in Patients After Intestinal Surgery for Crohn’s Disease

2019 ◽  
Vol 25 (9) ◽  
pp. 1559-1568 ◽  
Author(s):  
Chang Sik Yu ◽  
Sung Woo Jung ◽  
Jong Lyul Lee ◽  
Seok-Byung Lim ◽  
In Ja Park ◽  
...  
Keyword(s):  
Risk Factors ◽  
Crohn’S Disease ◽  
Postoperative Complications ◽  
Crohn's Disease ◽  
Bowel Resection ◽  
Abdominal Sepsis ◽  
Infectious Complications ◽  
Time Of Surgery ◽  
Tnf Α ◽  
Resection And Anastomosis

Abstract Background Many patients with Crohn’s disease (CD) are treated with medications, including steroids, immunomodulators, and anti–tumor necrosis factor alpha (anti-TNF-α) agents, at the time of surgery. This study evaluated the effects of these medications on postoperative complications in CD patients. Methods This retrospective study analyzed patients who underwent bowel resection for CD between January 2006 and December 2015. Postoperative complications were defined as a Clavien-Dindo classification of grade 2A or higher within the first 30 days after surgery. Results Of the 817 patients enrolled, 687 patients received bowel resection and anastomosis without stoma formation. Of 687 patients, 381 (55.5%) were being treated with preoperative medications at the time of surgery (medication group) and 306 (44.5%) were not (nonmedication group). The overall rate of postoperative complications was not different between the medication and nonmedication groups (23.4% vs 21.9%, P = 0.36). Preoperative treatments with immunomodulators plus anti-TNF-α agents (relative risk [RR], 2.314; 95% confidence interval [CI], 1.126–4.753; P = 0.022) and treatment with immunomodulators plus steroids (RR, 2.536; 95% CI, 1.124–5.725; P = 0.025) were risk factors for infectious complications. Preoperative treatments with immunomodulators plus anti-TNF-α agents (RR, 2.731; 95% CI, 1.102–6.769; P = 0.03) and treatment with immunomodulators plus steroids (RR, 3.118; 95% CI, 1.169–8.320; P = 0.023) were significantly associated with increased risk of intra-abdominal sepsis. Conclusions Preoperative treatments with immunomodulators plus anti-TNF-α agents or steroids were risk factors for infectious complications, especially intra-abdominal sepsis in patients who underwent bowel resection and anastomosis.

Vedolizumab in the Perioperative Management of Inflammatory Bowel Disease

2019 ◽  
Vol 20 (13) ◽  
pp. 1317-1322 ◽  
Author(s):  
Amy L. Lightner ◽  
Edward V. Loftus ◽  
Nicholas P. McKenna ◽  
Laura E. Raffals
Keyword(s):  
Inflammatory Bowel Disease ◽  
Crohn’S Disease ◽  
Postoperative Complications ◽  
Crohn's Disease ◽  
Bowel Disease ◽  
Perioperative Management ◽  
Chronically Ill ◽  
Infectious Complications ◽  
Increased Risk ◽  
Inflammatory Bowel

Background: : The isolated effect of vedolizumab on increased postoperative complications remains debated, similar to the controversial data on anti-TNF and postoperative complications. Objective: : To determine the risk of vedolizumab on postoperative complications. Method:: A review of the literature available to date on studies comparing postoperative outcomes in vedolizumab-treated versus non-vedolizumab-treated patients was performed. Studies were stratified by those which combined all inflammatory bowel disease together, those specifically focusing on Crohn’s disease or ulcerative colitis individually, and those which included pediatric patients alone. Results:: The data remains controversial in both the adult and pediatric literature regarding the association of vedolizumab and increased postoperative complications. The strongest association between vedolizumab and an increased risk of postoperative infectious complications seems to be in the Crohn’s disease literature. Conclusion:: Vedolizumab may be associated with an increased risk of postoperative infectious complications in Crohn’s disease, but the literature remains controversial due to difficulty in isolating the effect of the biologic alone in a chronically ill, heterogeneous patient population who are on multiple medications including corticosteroids.

scholarly journals Abdominal Surgery in Crohn’s Disease: Risk Factors for Complications

2020 ◽  
pp. 1-7
Author(s):  
Cintia Mayumi Sakurai Kimura ◽  
Arceu Scanavini Neto ◽  
Natalia Sousa Freitas Queiroz ◽  
Natally Horvat ◽  
Mariane Gouvea Monteiro Camargo ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Postoperative Complications ◽  
Crohn's Disease ◽  
Abdominal Surgery ◽  
Disease Risk ◽  
Factors Associated ◽  
Urgent Surgery ◽  
Preoperative Optimization ◽  
Increased Risk ◽  
Disease Location

<b><i>Introduction:</i></b> Abdominal surgery in patients with Crohn’s disease (CD) is challenging, especially in the biologic era. The aim of this study was to evaluate factors associated with increased risk for postoperative complications in CD. <b><i>Methods:</i></b> A retrospective study was conducted with consecutive patients who underwent abdominal surgery for CD from January 2012 to January 2018. <b><i>Results:</i></b> Of 103 patients, 32% had postoperative complications. Gender, age, disease location and phenotype, hemoglobin and albumin levels, previous abdominal surgery, and preoperative optimization did not differ between the groups with or without complications. Thirty-five percent of the patients were under anti-TNF therapy, and this medication was not associated with increased risk for postoperative complications. Time since the onset of the disease was significantly higher in patients with complications (12.9 vs. 9.4, <i>p</i> = 0.04). In multivariate analysis, creation of ostomy and urgent surgery were the only variables independently associated with increased risk for complications (OR 3.2, 95% CI 1.12–9.46 and OR 2.94, 95% CI 0.98–9.09, respectively). <b><i>Conclusion:</i></b> Urgent surgery for CD should preferably be performed in specialized centers, and creation of stoma is not necessarily associated with lower rate of postoperative complications but rather less severe complications.

scholarly journals Purine analogues as a risk factor of postoperative complications in abdominal surgery for Crohn’s disease

2012 ◽  
Vol 1 ◽  
pp. 13-19
Author(s):  
Katarzyna Borycka-Kiciak ◽  
Adam Kiciak ◽  
Łukasz Janaszek ◽  
Paweł Jaworski ◽  
Wiesław Tarnowski
Keyword(s):  
Risk Factor ◽  
Crohn’S Disease ◽  
Postoperative Complications ◽  
Crohn's Disease ◽  
Abdominal Surgery ◽  
Purine Analogues

P112 CORRELATION OF FECAL CALPROTECTIN TO COLONOSCOPIC FINDINGS FOR DETECTION OF RECURRENCE OF CROHN’S DISEASE IN THE POST-OPERATIVE SETTING AT A SINGLE ACADEMIC CENTER

2020 ◽  
Vol 26 (Supplement_1) ◽  
pp. S17-S17
Author(s):  
Anil Sharma ◽  
Georgia Morrison ◽  
Kian Keyashian ◽  
Rebecca Matro
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Small Sample Size ◽  
Rank Correlation ◽  
Fecal Calprotectin ◽  
Small Sample ◽  
Operating Characteristics ◽  
Repeat Surgery ◽  
Endoscopic Recurrence ◽  
Noninvasive Biomarkers

Abstract Introduction Patients with Crohn’s disease (CD) who undergo a first surgery are at higher risk of having a subsequent surgery in light of recurrence of disease. Significant evidence suggests that a postoperative colonoscopy evaluating recurrence at the anastomosis using the Rugeerts score (RS) can predict risk of repeat surgery. Given the invasive nature of colonoscopy, there has been increasing interest in using noninvasive biomarkers to predict disease recurrence. Studies have shown variability in the operating characteristics of the fecal calprotectin (FC) assay with sensitivities and specificities for detecting recurrence ranging widely from 48–95 and 58–79%, respectively. A recent meta-analysis demonstrated a pooled sensitivity of 70% when using an optimal FC cut-off of 150 ug/g. We sought to delineate how FC correlates with RS at our institution and to identify a cutoff for significant recurrence. Methods We performed a retrospective review of adult patients with CD who underwent ileocecectomy followed by a colonoscopy within 18 months of surgery, with the additional inclusion of FC testing within 2 weeks of the colonoscopy. Patients were identified at our institution via ICD 9 and 10 codes and the electronic medical record. The primary outcome of interest was a comparison of mean FC for those without endoscopic recurrence (defined as RS i0-i1) to those with significant endoscopic recurrence (defined as RS i2-i4). Other variables assessed included gender, disease location and phenotype, and extent of surgery (Table 1). Results A total of 12 patients met the inclusion criteria. 7 patients (58.3%) were female. Age at time of surgery ranged from 21 to 73 years (mean 37.9). Only 1 patient (8.3%) had a nonstricturing, nonpenetrating phenotype. After surgery, 11 patients were on biologic or combination therapy and 1 patient was not on any medical therapy. 5 patients (42%) demonstrated endoscopic recurrence by RS with mean FC of 883.7 ug/g, as compared to mean FC of 83.6 ug/g for those without recurrence. There was a positive correlation between FC and RS with a Spearman’s rank correlation coefficient of 0.86 (p = 0.0004). Conclusions Our results demonstrate a strong correlation between FC and RS. Using a cutoff for FC of 150 ug/g, we demonstrate sensitivity and specificity of 100%. This further supports the possibility of using FC as a surrogate to possibly defer colonoscopy in those post-operative CD patients with low FC. Study limitations include the retrospective nature and small sample size, recognizing that in years past FC was not as readily available or used in this setting. Future considerations include larger, prospective studies looking at FC and other noninvasive biomarkers in this post-operative setting.

Body mass index: Implications on disease severity and postoperative complications in patients with Crohn’s disease undergoing abdominal surgery

Surgery ◽  
2019 ◽  
Vol 166 (4) ◽  
pp. 703-708 ◽  
Author(s):  
Nicholas P. McKenna ◽  
Elizabeth B. Habermann ◽  
Martin D. Zielinski ◽  
Amy L. Lightner ◽  
Kellie L. Mathis
Keyword(s):  
Body Mass Index ◽  
Crohn’S Disease ◽  
Postoperative Complications ◽  
Crohn's Disease ◽  
Abdominal Surgery ◽  
Disease Severity ◽  
Body Mass

scholarly journals The role of TNF-alpha gene (-238G/A and -308G/A) polymorphisms in the etiology and pathogenesis of inflammatory bowel diseases in various ethnic groups

2019 ◽  
Vol 47 (6) ◽  
pp. 548-558
Author(s):  
I. V. Zhilin ◽  
E. Yu. Chashkova ◽  
A. A. Zhilina ◽  
B. S. Pushkarev ◽  
N. S. Korotaeva
Keyword(s):  
Ulcerative Colitis ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Gene Polymorphism ◽  
Ethnic Groups ◽  
Small Sample ◽  
Tnf Α ◽  
Study Results ◽  
Inflammatory Bowel

This literature review deals with specifics of the natural course of inflammatory bowel disease (IBD) in patients from various ethnic groups and -308G/A and -238G/A promoter polymorphisms in tumor necrosis factor-alpha (TNF-α) gene. The search in PubMed, Medline, Еlibrary.ru databases has led to identify in total 20 studies, including 2 meta-analyses, on the role of TNF-α-308G/A and -238G/A gene polymorphism in the etiology and pathophysiology of IBD. The TNF-α-308G/A polymorphism is associated with increased secretion of this proinflammatory cytokine, whereas the TNF-α-238G/A genotype is characterized by reduced TNF-α secretion. A  number of studies have shown an association between TNF-α-308G/A gene polymorphism and severe course of IBD, requiring more active treatment of patients (cytostatics, corticosteroids, biological agents). Some investigators have found that the patients carriers of TNF-α-308G/A had a  higher probability of surgical interventions. The association between TNF-α-308G/A and the phenotypic characteristics of IBD has been identified in studies performed in Europe, Asia, and Russia. The association of this polymorphism with the prevalence of ulcerative colitis has been proven in some studies, in particular, in the Asian population. Similar associations have been noted in few publications originating from Europe and North America, while some studies have found no links between TNF-α-308G/A, -238G/A, and the course of IBD. TNF-α-238G/A gene polymorphism has not shown any significance for the prevalence and course of ulcerative colitis and Crohn's disease. One can assume that the differences in the study results arising from one and the same geographical area are related to genetic heterogeneity of the study groups, phenotypic variances between the study subjects, as well as relatively small sample sizes. Currently, the search for genetic, biochemical and other prognostic criteria for IBD course is in progress. There are studies in progress to investigate the mechanisms of transformation of the genetic information into the particulars of ulcerative colitis and Crohn's disease manifestations, with consideration of ethnicity.

scholarly journals Effect of Thiopurine on Potential Surgical Intervention in Crohn’s Disease in Korea: Results from the CONNECT Study

2020 ◽  
Vol 10 (1) ◽  
pp. 25 ◽  
Author(s):  
Hee Man Kim ◽  
Jin Woo Kim ◽  
Hyun-Soo Kim ◽  
Joo Sung Kim ◽  
You Sun Kim ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Abdominal Surgery ◽  
Odds Ratio ◽  
Republic Of Korea ◽  
Control Groups ◽  
Tnf Α ◽  
The Republic ◽  
And Control ◽  
Reduced Risk

Objectives: The incidence of Crohn’s disease and the number of associated surgeries are increasing in Korea. This study investigated the effect of azathioprine/6-mercaptopurine (6-MP) and TNF-α antagonists on abdominal and perianal surgery in Korean patients with Crohn’s disease. Design: A retrospective cohort study. Setting: Data from the Crohn’s Disease Clinical Network and Cohort (CONNECT) were used. Patients with confirmed Crohn’s disease between 1982 and 2008 from 32 hospitals in the Republic of Korea were enrolled. The effect of azathioprine/6-MP on abdominal and perianal surgery was analysed using logistic regression analysis adjusting for age and sex. Participants: In total, 1161 Crohn’s disease patients were included in the Republic of Korea in the surgery (n = 462, male = 339, female = 123) and control groups (n = 699, male = 484, female = 215). Results: In total, 1161 patients were selected, with 462 patients who underwent abdominal (n = 245) or perianal surgery (n = 217). The preoperative usage rates of azathioprine/6-MP were 18.8% and 65.1% (p < 0.0001) in the surgery and control groups, respectively. The preoperative usage rates of TNF-α antagonists were 7.1% and 23.3% (p < 0.0001) in the surgery and control groups, respectively. A multivariate analysis revealed that the preoperative use of azathioprine/6-MP had an odds ratio of 0.094 for all surgeries (95% confidence interval [CI]: 0.070–0.127, p < 0.0001), 0.131 for abdominal surgery (95% CI: 397–1.599, p < 0.0001), and 0.059 for perianal surgery (95% CI: 0.038–0.091, p < 0.0001). The preoperative use of TNF-α antagonists had an odds ratio of 0.225 for all surgeries (95% CI: 0.151–0.335, p < 0.0001), 0.403 for abdominal surgery (95% CI: 0.261–0.623, p < 0.0001), and 0.064 for perianal surgery (95% CI: 0.026–0.160, p < 0.001). Strengths of this study: The study presents new evidence of the reduced risk of surgery following azathioprine use in Crohn’s disease patients. Limitations of this study (1) This was not a controlled prospective study. (2) There was a selection bias specific to the CONNECT cohort. (3) The combination or sequential use of azathioprine/6-MP and TNF-α antagonists was not excluded. Conclusion: Azathioprine/6-MP is significantly associated with a reduced risk of abdominal and perianal surgery in Korean patients with Crohn’s disease.

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