Abstract
BackgroundAlthough biologic agents have revolutionized the medical management of severe ulcerative colitis (UC), there is considerable controversy regarding adverse effects of vedolizumab on surgical outcomes. We evaluated 30-day postoperative morbidity in UC patients undergoing abdominal colectomy (AC) treated with vedolizumab before surgery.MethodsFrom 2007 to 2017, 285 patients were enrolled in prospectively maintained database evaluating the role of clinical, serologic markers with clinical phenotypes in UC. The patients treated with vedolizumab within 12 weeks of AC was queried, then matched 1:3:3 into 3 preoperative treatment groups based on age, gender and surgical treatment of UC; ileal pouch-anal anastomosis (IPAA) with ileostomy vs total colectomy with end stoma: a) vedolizumab (n = 25); b) anti-tumor necrosis factor (anti-TNF) (n = 74); and c) no biologics (n = 54). Thirty-day postoperative complications among patient groups were compared.ResultsThe 3 patient groups were well-matched in other characteristics including disease duration, disease extent, medication history and preoperative serological data. There were no significant differences in the overall incidence of postoperative complications among patients treated preoperatively with vedolizumab, anti-TNFs, or no biologics (44% vs. 45% vs. 37%; p = 0.67). Although there was no significant difference between patient cohorts in infectious complications (p = 0.20), postoperative ileus (POI) was significantly more common among the vedolizumab group (n = 9; 36%) compared to anti-TNF (n = 12; 16%) or no biologics (n = 5; 9%) (p = 0.01). Multivariable analysis showed that vedolizumab treatment prior to surgery was an independent risk factor for POI (OR: 5.16, 95% CI; 1.71–15.52; p = .004).ConclusionAlthough preoperative vedolizumab exposure did not influence the rate of overall 30-day postoperative complications, vedolizumab tends to increase incidence of POI.
Highlights
Biologic agents have revolutionized the medical management of severe ulcerative colitis (UC), there is considerable controversy regarding adverse effects of vedolizumab on surgical outcomes
We used 1:3 matching based on age, gender and number of stages of patients treated with vedolizumab, of 77 patients with non-biologics, only 54 patients were eligible for matching condition
There were no significant statistical differences in clinical characteristics between the three groups, age was relatively older in non-biologics (37 vs 32 vs 31, p = 0.13), and previous medication of 6-MP or methotrexate rate was relatively less in the non-biologic group than the other two groups (45% vs 84% vs 80%, p = 0.001)
Summary
Biologic agents have revolutionized the medical management of severe ulcerative colitis (UC), there is considerable controversy regarding adverse effects of vedolizumab on surgical outcomes. By targeting various host immune molecules such as tumor necrosis factor (TNF), interleukins and adhesion molecules present on the surfaces of lymphocytes, biologics agents have revolutionized the medical management of inflammatory bowel disease (IBD). Despite these improvements, the need for surgical intervention in IBD. Vedolizumab is a gut specific humanized monoclonal antibody which selectively binds to the α4β7 integrin, thereby blocking its interaction with mucosal addressin cell adhesion molecule-1 (MAdCAM-1) This action inhibits the migration of lymphocytes into the gastrointestinal lymph tissue and arrests the chronic inflammatory state of both ulcerative colitis (UC) and Crohn’s disease (CD). We hypothesized that postoperative complications would be comparable across vedolizumab treated, antiTNF treated and no biologic patient groups
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