Eur J Pediatr Surg 2020; 30(01): 027-032
DOI: 10.1055/s-0039-1697909
Original Article
Georg Thieme Verlag KG Stuttgart · New York

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

1   Department of Pediatric Surgery, 2nd Faculty of Medicine, Charles University in Prague, University Hospital Motol, Prague, Czech Republic
,
Jiri Bronsky
2   Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague, University Hospital Motol, Prague, Czech Republic
,
Ondrej Hradsky
2   Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague, University Hospital Motol, Prague, Czech Republic
,
Barbora Frybova
1   Department of Pediatric Surgery, 2nd Faculty of Medicine, Charles University in Prague, University Hospital Motol, Prague, Czech Republic
,
Stepan Coufal
3   Laboratory of Cellular and Molecular Immunology, Institute of Microbiology of The Czech Academy of Sciences, v.v.i. Prague, Czech Republic
,
Richard Skaba
1   Department of Pediatric Surgery, 2nd Faculty of Medicine, Charles University in Prague, University Hospital Motol, Prague, Czech Republic
,
Michal Rygl
1   Department of Pediatric Surgery, 2nd Faculty of Medicine, Charles University in Prague, University Hospital Motol, Prague, Czech Republic
› Institutsangaben
Weitere Informationen

Publikationsverlauf

14. Mai 2019

20. August 2019

Publikationsdatum:
10. Oktober 2019 (online)

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.

 
  • References

  • 1 Gasparetto M, Guariso G. Highlights in IBD epidemiology and its natural history in the paediatric age. Gastroenterol Res Pract 2013; 2013: 829040
  • 2 de Bie C, Paerregaard A, Kolacek S. , et al. Disease phenotype at diagnosis in pediatric Crohnʼs disease. : 5-year analyses of the EUROKIDS Registry. Inflamm Bowel Dis 2013; 19 (02) 378-385
  • 3 Mowat C, Cole A, Windsor A. , et al; IBD Section of the British Society of Gastroenterology. Guidelines for the management of inflammatory bowel disease in adults. Gut 2011; 60 (05) 571-607
  • 4 Hanauer SB, Feagan BG, Lichtenstein GR. , et al; ACCENT I Study Group. Maintenance infliximab for Crohn's disease: the ACCENT I randomised trial. Lancet 2002; 359 (9317): 1541-1549
  • 5 Hanauer SB, Sandborn WJ, Rutgeerts P. , et al. Human anti-tumor necrosis factor monoclonal antibody (adalimumab) in Crohn's disease: the CLASSIC-I trial. Gastroenterology 2006; 130 (02) 323-333
  • 6 Colombel JF, Sandborn WJ, Rutgeerts P. , et al. Adalimumab for maintenance of clinical response and remission in patients with Crohn's disease: the CHARM trial. Gastroenterology 2007; 132 (01) 52-65
  • 7 Rutgeerts P, Feagan BG, Lichtenstein GR. , et al. Comparison of scheduled and episodic treatment strategies of infliximab in Crohn's disease. Gastroenterology 2004; 126 (02) 402-413
  • 8 Sandborn WJ, Rutgeerts P, Enns R. , et al. Adalimumab induction therapy for Crohn disease previously treated with infliximab: a randomized trial. Ann Intern Med 2007; 146 (12) 829-838
  • 9 Vernier-Massouille G, Balde M, Salleron J. , et al. Natural history of pediatric Crohn's disease: a population-based cohort study. Gastroenterology 2008; 135 (04) 1106-1113
  • 10 Xu Y, Yang L, An P, Zhou B, Liu G. Meta-analysis: the influence of preoperative infliximab use on postoperative complications of Crohn's disease. Inflamm Bowel Dis 2019; 25 (02) 261-269
  • 11 Chang M, Cohen B, Greenstein A. A Review of the Impact of Biologics on Surgical Complications in Crohn's Disease. Inflammatory Bowel Diseases 2015; 21 (06) 1472-1477
  • 12 Rosenfeld G, Qian H, Bressler B. The risks of post-operative complications following pre-operative infliximab therapy for Crohn's disease in patients undergoing abdominal surgery: a systematic review and meta-analysis. J Crohn's Colitis 2013; 7 (11) 868-877
  • 13 Levine A, Koletzko S, Turner D. , et al. The ESPGHAN revised Porto criteria for the diagnosis of inflammatory bowel disease in children and adolescents. J Pediatr Gastroenterol Nutr 2014; 58 (06) 795-806
  • 14 Ruemmele FM, Veres G, Kolho KL. , et al; European Crohn's and Colitis Organisation; European Society of Pediatric Gastroenterology, Hepatology and Nutrition. Consensus guidelines of ECCO/ESPGHAN on the medical management of pediatric Crohn's disease. J Crohn's Colitis 2014; 8 (10) 1179-1207
  • 15 Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240 (02) 205-213
  • 16 Bemelman W, Warusavitarne J, Sampietro G. , et al. ECCO-ESCP consensus on surgery for Crohn's disease. J Crohn's Colitis 2018; 12 (01) 1-16
  • 17 Amil-Dias J, Kolacek S, Turner D. , et al; IBD Working Group of ESPGHAN (IBD Porto Group). Surgical management of Crohn disease in children: guidelines from the paediatric IBD Porto group of ESPGHAN. J Pediatr Gastroenterol Nutr 2017; 64 (05) 818-835
  • 18 Lightner AL, McKenna NP, Alsughayer A. , et al. Anti-TNF biologic therapy does not increase postoperative morbidity in pediatric Crohn's patients. J Pediatr Surg 2019; S0022-3468(19)30015-6
  • 19 Abbas PI, Peterson ML, Fallon SC. , et al. Evaluating the impact of infliximab use on surgical outcomes in pediatric Crohn's disease. J Pediatr Surg 2016; 51 (05) 786-789
  • 20 Zimmerman LA, Saites CG, Bairdain S. , et al. Postoperative complications in children with Crohn disease treated with infliximab. J Pediatr Gastroenterol Nutr 2016; 63 (03) 352-356
  • 21 Mitsuya JB, Gonzalez R, Thomas R, El-Baba M. The effect of biologics on postoperative complications in children with inflammatory bowel disease and bowel resection. J Pediatr Gastroenterol Nutr 2019; 68 (03) 334-338
  • 22 Nasir BS, Dozois EJ, Cima RR. , et al. Perioperative anti-tumor necrosis factor therapy does not increase the rate of early postoperative complications in Crohn's disease. J Gastrointest Surg 2010; 14 (12) 1859-1865
  • 23 Syed A, Cross RK, Flasar MH. Anti-tumor necrosis factor therapy is associated with infections after abdominal surgery in Crohn's disease patients. Am J Gastroenterol 2013; 108 (04) 583-593
  • 24 Yang ZP, Hong L, Wu Q, Wu KC, Fan DM. Preoperative infliximab use and postoperative complications in Crohn's disease: a systematic review and meta-analysis. Int J Surg 2014; 12 (03) 224-230