Background: Biological therapy with anti-Tumour Necrosis Factor (TNF)-α agents
revolutionised the treatment of inflammatory bowel disease over the last decades. However,
there may be an increased risk of postoperative complications in Crohn’s disease (CD) patients
treated with anti-TNF-α agents prior to abdominal surgery.
Objective: To evaluate the effects of preoperative anti-TNF-α therapy on the incidence of complications
Methods: A critical assessment of the results of clinical trial outcomes and meta-analyses on the
available data was conducted.
Results: Based on the outcomes of previous reports including meta-analyses, preoperative use of anti-
TNF-α agents modestly increased the risk of overall complications and particularly infectious
complications after abdominal surgery for CD. Nevertheless, previous studies have several limitations.
The majority of them were retrospective research with heterogeneous outcome measures and
single centre trials with relatively small sample size. In retrospective studies, the standard protocol
for assessing various types of postoperative complications was not used. The most serious limitation
of the previous studies was that multiple confounding factors such as malnutrition, use of
corticosteroids, and preoperative sepsis were not taken into consideration.
Conclusion: Among patients treated with preoperative anti-TNF-α therapy, the risk of overall complications
and infectious complications may slightly increase after abdominal surgery for CD.
Nevertheless, the previous reports reviewed in this study suffered from limitations. To rigorously
evaluate the risk of anti-TNF-α therapy prior to surgery, large prospective studies with standardised
criteria for assessing surgical complications and with proper adjustment for confounding
variables are warranted.