Biologic therapy and surgery for crohn disease
1Department of Surgery, Philadelphia VA Medical Center, Philadelphia, Pennsylvania.
Clinics in Colon and Rectal Surgery
|January 18, 2014
Summary
Biologic therapies, including anti-tumor necrosis factor alpha (anti-TNF-α) agents, do not significantly increase postoperative complications in Crohn disease (CD) patients. However, more research is needed to confirm these findings for Crohn disease surgery.
Area of Science:
- Gastroenterology
- Immunology
- Surgical Oncology
Background:
- Biologic therapies, such as infliximab (anti-tumor necrosis factor alpha [anti-TNF-α]), adalimumab, certolizumab pegol, and natalizumab, are increasingly used for Crohn disease (CD).
- The use of these therapies around the time of surgery in CD patients raises concerns about potential postoperative complications.
Purpose of the Study:
- To review and synthesize existing literature on the relationship between pre- and postoperative biologic therapy and surgical outcomes in patients with Crohn disease.
Main Methods:
- Systematic review of published studies examining the impact of perioperative biologic therapy on postoperative complications in CD patients.
- Analysis of heterogeneous, retrospective studies with conflicting results.
Main Results:
- The available data suggest that perioperative biologic therapy does not significantly elevate the risk of postoperative complications in CD patients.
- However, the existing literature is characterized by numerous small, retrospective, and heterogeneous studies, limiting definitive conclusions.
Conclusions:
- Current evidence indicates no significant increase in postoperative complications with perioperative biologic therapy in Crohn disease.
- Larger, prospective studies are essential to definitively ascertain the risks associated with biologic therapy in CD patients undergoing surgery.
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