Short-term outcomes of laparoscopic surgery for Crohn's disease patients treated with anti-tumor necrosis factor alpha agents.

Abstract

The impact of anti-tumor necrosis factor alpha (TNFα) treatment for Crohn's disease (CD) on surgical outcomes is still controversial. The aim of this study was to assess the feasibility of laparoscopic surgery for CD patients treated preoperatively with anti-TNFα agents. We investigated, retrospectively, the clinical features and surgical outcomes of 35 consecutive CD patients who underwent laparoscopic surgery after receiving scheduled anti-TNFα treatment preoperatively. We compared the surgical outcomes of an "early surgery group", comprised of patients who underwent surgery less than 3years after the initiation of anti-TNFα treatment, with those of a "late surgery group", comprised of patients who underwent surgery more than 3years after the initiation of anti-TNFα treatment. The mean operating time and blood loss were 203min and 259mL, respectively. The rates of conversion to open surgery and postoperative complications were 8.6 and 11.4%, respectively. Operating time and blood loss were correlated with the interval between the initiation of anti-TNFα agent treatment and the time of surgery. The proportion of patients with acquired resistance to anti-TNFα agents and the rate of conversion to open surgery were higher and operating times were longer in the late surgery group than in the early surgery group. Laparoscopic surgery can be performed safely for CD patients treated preoperatively with anti-TNFα agents, although operating times may be longer and estimated blood loss (EBL) greater for those who have been on prolonged anti-TNFα treatment.