Tsuyoshi Hata1, Tsunekazu Mizushima2,3, Hideki Osawa1, Hidekazu Takahashi1, Naotsugu Haraguchi1, Junichi Nishimura1, Taishi Hata1, Ichiro Takemasa1,4, Masakazu Ikenaga1,5, Kiyokazu Nakajima1, Hirofumi Yamamoto1, Kohei Murata1,6, Yuichiro Doki1, Masaki Mori1. 1. Department of Surgery, Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan. 2. Department of Surgery, Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan. tmizushima@gesurg.med.osaka-u.ac.jp. 3. Department of Therapeutics for Inflammatory Bowel Diseases, Graduate School of Medicine, Osaka University, Osaka, Japan. tmizushima@gesurg.med.osaka-u.ac.jp. 4. Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan. 5. Department of Surgery, Higashiosaka City General Hospital, Osaka, Japan. 6. Department of Surgery, Suita Municipal Hospital, Osaka, Japan.
Abstract
PURPOSE: 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. METHODS: 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 3 years after the initiation of anti-TNFα treatment, with those of a "late surgery group", comprised of patients who underwent surgery more than 3 years after the initiation of anti-TNFα treatment. RESULTS: The mean operating time and blood loss were 203 min and 259 mL, 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. CONCLUSION: 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.
PURPOSE: The impact of anti-tumornecrosis 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 CDpatients treated preoperatively with anti-TNFα agents. METHODS: We investigated, retrospectively, the clinical features and surgical outcomes of 35 consecutive CDpatients 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 3 years after the initiation of anti-TNFα treatment, with those of a "late surgery group", comprised of patients who underwent surgery more than 3 years after the initiation of anti-TNFα treatment. RESULTS: The mean operating time and blood loss were 203 min and 259 mL, 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. CONCLUSION: Laparoscopic surgery can be performed safely for CDpatients 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.
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