Tumor Necrosis Factor Alpha Inhibitors Reduce Staged Surgery Rate and Prevent Postoperative Endoscopic Recurrence in
Qinglu Yang1,2, Jiaolan Yang1, Pengyun Yin1
1Department of Gastroenterology, Shanghai Tenth People's Hospital, Shanghai, China.
Background:
The impact of preoperative tumor necrosis factor alpha inhibitors on surgical outcomes in Crohn's disease remains controversial, whereas postoperative tumor necrosis factor alpha inhibitors are known to prevent endoscopic recurrence.
Objective:
To evaluate whether preoperative tumor necrosis factor alpha inhibitors reduce the need for staged surgery without increasing complications, and whether postoperative tumor necrosis factor alpha inhibitors decrease endoscopic postoperative recurrence.
Design:
Retrospective observational cohort study.
Setting:
Inflammatory Bowel Disease Surgery Centre, Shanghai Tenth People's Hospital, China.
Patients:
A total of 202 patients with Crohn's disease undergoing bowel resection (June 2019-June 2024). Follow-up included 143 patients at 6 months and 116 at 1 year.
Interventions:
Preoperative tumor necrosis factor alpha inhibitors (within 12 weeks before surgery) or postoperative tumor necrosis factor alpha inhibitors (initiated more than 2 weeks after surgery) compared with no use of tumor necrosis factor alpha inhibitors.
Main Outcome Measures:
Staged surgery rate, complications, hospital stay, and endoscopic postoperative recurrence (Rutgeerts score greater than or equal to i2) at 6 months and 1 year.
Results:
Patients who received reoperative tumor necrosis factor alpha inhibitors had significantly reduced staged surgery compared with inhibitor-naive patients (39.7% vs 60.5%; OR 0.43, p = 0.01). No differences were found in hospital stay, 1-month complications (13.7% vs 14%), or 1-year reoperation rates (9.5% vs 4.1%). Postoperative tumor necrosis factor alpha inhibitors significantly reduced endoscopic recurrence at 6 months (18.7% vs 35.3%; OR 0.42, p = 0.03) and 1 year (22.4% vs 39.7%; OR 0.44, p = 0.05). One-year reoperation complication rates were similar (3.5% vs 8.6%, p = 0.44).
Limitations:
Retrospective design; selection bias; single-center study.
Conclusions:
Preoperative use of tumor necrosis factor alpha inhibitors reduces the need for staged surgery without increasing complications. Postoperative tumor necrosis factor alpha inhibitors effectively reduce endoscopic recurrence at 6 months and 1 year. Perioperative use appears safe and beneficial for patients with Crohn's disease who require surgery. See Video Abstract .
Los Inhibidores Del Factor De Necrosis Tumoral Alfa Reducen La Tasa De Ciruga Por Etapas Y Previenen La Recurrencia Endoscpica Posoperatoria En Pacientes Con Enfermedad De Crohn:
ANTECEDENTES:El impacto de los inhibidores del factor de necrosis tumoral preoperatorios en los resultados quirúrgicos de la enfermedad de Crohn sigue siendo controvertido, mientras que se sabe que los inhibidores del factor de necrosis tumoral postoperatorios previenen la recurrencia endoscópica.OBJETIVO:Evaluar si los inhibidores del factor de necrosis tumoral preoperatorios reducen la necesidad de cirugía por etapas sin aumentar las complicaciones, y si los inhibidores del factor de necrosis tumoral postoperatorios disminuyen la recurrencia endoscópica postoperatoria.DISEÑO:Estudio de cohorte observacional retrospectivo.ESCENARIO:Centro de Cirugía de la Enfermedad Inflamatoria Intestinal, Décimo Hospital Popular de Shanghái, China.PACIENTES:Un total de 202 pacientes con enfermedad de Crohn sometidos a resección intestinal (junio de 2019 - junio de 2024). El seguimiento incluyó a 143 pacientes a los 6 meses y a 116 al año. INTERVENCIONES: Inhibidores del factor de necrosis tumoral preoperatorios (en las 12 semanas previas a la cirugía) o inhibidores del factor de necrosis tumoral postoperatorios (iniciados más de 2 semanas después de la cirugía) versus pacientes sin tratamiento previo con inhibidores del factor de necrosis tumoral.PRINCIPALES MEDIDAS DE RESULTADOS:Tasa de cirugía por etapas, complicaciones, estancia hospitalaria y recurrencia postoperatoria endoscópica (puntuación de Rutgeerts ≥ i2) a los 6 meses y al año.RESULTADOS:Los inhibidores del factor de necrosis tumoral preoperatorios redujeron significativamente la cirugía por etapas en comparación con los pacientes sin tratamiento previo (39,7 % frente a 60,5 %; odds ratio: 0,43; p = 0,01). No se encontraron diferencias en la estancia hospitalaria, las complicaciones al mes (13,7 % frente a 14 %) ni en las tasas de reintervención al año (9,5 % frente a 4,1 %). Los inhibidores del factor de necrosis tumoral (INF) postoperatorios redujeron significativamente la recurrencia endoscópica a los 6 meses (18,7 % frente a 35,3 %; odds ratio: 0,42; p = 0,03) y al año (22,4 % frente a 39.7 %; odds ratio: 0,44; p = 0,05). Las tasas de complicaciones de la reintervención al año fueron similares (3,5 % frente a 8,6 %, p = 0,44).LIMITACIONES:Diseño retrospectivo; sesgo de selección; estudio unicéntrico.CONCLUSIONES:Los inhibidores del factor de necrosis tumoral (INF) preoperatorios reducen la necesidad de cirugía por etapas sin aumentar las complicaciones. Los INF postoperatorios reducen eficazmente la recurrencia endoscópica a los 6 meses y al año. Su uso perioperatorio parece seguro y beneficioso para los pacientes con enfermedad de Crohn que requieren cirugía. ( AI-generated translation ).
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