Infliximab does not increase the risk of early postoperative complications in UC patients after a three-stage restorative proctocolectomy with IPAA

Czech version

Authors: M. Kostrejová ¹; M. Bortlík ^2,3; M. Lukáš ^2,4; D. Ďuricová ^2,5; R. Mudr ¹; A. Komárek ⁶; R. Sequens ¹
Authors‘ workplace: Gastroenterologické oddělení, Nemocnice Milosrdných sester sv. Karla Boromejského, Praha ¹; Klinické a výzkumné centrum pro střevní záněty ISCARE I. V. F. a. s. a 1. LF UK, Praha ²; Interní klinika 1. LF UK a ÚVN, Praha ³; Ústav lékařské biochemie a laboratorní diagnostiky, 1. LF UK a VFN, Praha ⁴; Ústav farmakologie, 1. LF UK, Praha ⁵; Katedra pravděpodobnosti a matematické statistiky MFF UK, Praha ⁶
Published in: Gastroent Hepatol 2014; 68(1): 14-18
Category: IDB: Original Article

Overview

Introduction and aim:
Patients with ulcerative colitis (UC) treated with infliximab (IFX) preoperatively are theoretically at increased risk of complications after restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA). The aim was to compare the occurrence of early postoperative complications among patients treated and not treated with IFX.

Methods:
A retrospective analysis of different types of early postoperative complications in UC patients treated and not treated with IFX.

Results:
Between January 2006 and December 2012, 138 UC patients underwent surgical therapy. Of these patients, 108 had restorative proctocolectomy and IPAA. Forty-seven patients received IFX preoperatively (IFX group), while 61 did not receive any IFX (No-IFX group). In total, early complications occurred in 40.4% of patients in the IFX group, and in 44.3% in the No-IFX group. Using logistic regression analysis, no statistically significant difference was found in the occurrence of any particular type of both surgical and non-surgical complications.

Conclusion:
We did not observe an increased occurrence of early postoperative complications in UC patients after a three-stage restorative proctocolectomy with IPAA.

Key words:
ulcerative colitis – infliximab – restorative proctocolectomy – postoperative complications

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

Submitted:
17. 1. 2014

Accepted:
3. 2. 2014

Sources

1. Lukáš M. Současnost a budoucnost v léčbě ulcerózní kolitidy. Gastroent Hepatol 2013; 67(3): 212–218.

2. Dhillon S, Loftus EV Jr, Tremaine WJ et al. The natural history of surgery for ulcerative colitis in a population-based cohort from Olmsted County, Minnesota. Am J Gastroenterol 2005; 100: A819.

3. Bortlík M, Ďuricová D, Kohout P et al. Doporučení pro podávání biologické terapie u idiopatických střevních zánětů: 2. vydání. Gastroent Hepatol 2012; 66(1): 12–22.

4. Institut for Statistics and Mathematics of WU. The R project for statistical computing. Available from: www.r-project.org.

5. Lichtenstein GR, Feagan BG, Cohen RD et al. Serious infection and mortality in patients with Crohn’s disease: more than 5 years of follow-up in the TREAT registry. Am J Gastroenterol 2012; 107(9): 1409–1422. doi: 10.1038/ajg.2012.218.

6. Toruner M, Loftus EV Jr, Harmsen WS et al. Risk factors for opportunistic infections in patients with inflammatory bowel disease. Gastroenterology 2008; 134(4): 929–936. doi: 10.1053/j.gastro.2008.01.012.

7. Selvasekar CR, Cima RR, Larson DW et al. Effect of infliximab on short-term complications in patients undergoing operation for chronic ulcerative colitis. J Am Coll Surg 2007; 204(5): 956–962; discussion: 962–963.

8. Yang Z, Wu Q, Wu K et al. Meta-analysis: pre-operative infliximab treatment and short-term post-operative complications in patients with ulcerative colitis. Aliment Pharmacol Ther 2010; 31(4): 486–492. doi: 10.1111/j.1365-2036.2009.04204.x.

9. Šerclová Z, Lukáš M. Doporučené postupy v chirurgické léčbě IBD. Workshop pracovní skupiny. 5. kongres České gastroenterologické společnosti, Karlovy Vary 7.–9. 11. 2013.

10. Gu J, Remzi FH, Shen B et al. Operative strategy modifies risk of pouch-related outcomes in patients with ulcerative colitis on preoperative anti-tumor necrosis factor-α therapy. Dis Colon Rectum 2013; 56(11): 1243–1252. doi: 10.1097/DCR.0b013e3182a0e702.

11. Eshuis EJ, Al Saady RL, Stokkers PC et al. Previous infliximab therapy and postoperative complications after proctocolectomy with ileum pouch anal anastomosis. J Crohns Colitis 2013; 7(2): 142–149. doi: 10.1016/j.crohns.2012.03.013.

12. Billioud V, Ford AC, Tedesco ED et al. Preoperative use of anti-TNF therapy and postoperative complications in inflammatory bowel diseases: a meta-analysis. J Crohns Colitis 2013; 7(11): 853–867. doi: 10.1016/j.crohns.2013.01.014.

13. Waterman M, Xu W, Dinani A et al. Preoperative biological therapy and short-term outcomes of abdominal surgery in patients with inflammatory bowel disease. Gut 2013; 62(3): 387–394. doi: 10.1136/gutjnl-2011-301495.