Diana E Yung1, Nir Horesh2, Amy L Lightner3, Shomron Ben-Horin4, Rami Eliakim4, Anastasios Koulaouzidis1, Uri Kopylov4. 1. Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom. 2. Department of General Surgery B, Sheba Medical Center, Ramat-Gan, and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel. 3. Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA. 4. Department of Gastroenterology, Sheba Medical Center, Ramat-Gan, and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Abstract
Background: Several studies have reported the surgical outcomes of inflammatory bowel disease (IBD) patients exposed to vedolizumab (VDZ) preoperatively, with conflicting results. This meta-analysis aims to evaluate the risk of postoperative complications in IBD patients preoperatively exposed to VDZ in comparison with patients exposed to anti-tumor necrosis factor (anti-TNF) treatment or no biologic therapy. Methods: A systematic review with a meta-analysis of the existing literature was conducted. The main outcomes included the odds of developing overall postoperative complications, infectious complications, surgical site infections, need for repeat surgery, and major postoperative complications, as defined by the Clavien-Dindo criteria. Results: Four studies were included in the meta-analysis. The risk of all postoperative complications was not significantly different between IBD patients exposed preoperatively to VDZ vs anti-TNFs (odds ratio [OR], 0.64; 95% confidence interval [CI], 0.21-1.88). In patients with ulcerative colitis (UC), the OR for complications was significantly lower in VDZ-exposed as opposed to anti-TNF-exposed patients (OR, 0.35; 95% CI, 0.14-0.85); the comparison was insignificant in Crohn's disease. There were no significant differences in the risk of infectious complications, surgical site infections, need for reoperation, or major surgical complications in patients exposed to VDZ vs anti-TNFs. There were no significant differences in outcomes when comparing patients exposed to VDZ with those not given biologic therapy. Conclusions: This meta-analysis did not detect an increased risk of postoperative complications with preoperative VDZ exposure; the risk of overall complications may be lower in UC patients in comparison with those with anti-TNF exposure. These results merit further verification in future studies.
Background: Several studies have reported the surgical outcomes of inflammatory bowel disease (IBD) patients exposed to vedolizumab (VDZ) preoperatively, with conflicting results. This meta-analysis aims to evaluate the risk of postoperative complications in IBDpatients preoperatively exposed to VDZ in comparison with patients exposed to anti-tumornecrosis factor (anti-TNF) treatment or no biologic therapy. Methods: A systematic review with a meta-analysis of the existing literature was conducted. The main outcomes included the odds of developing overall postoperative complications, infectious complications, surgical site infections, need for repeat surgery, and major postoperative complications, as defined by the Clavien-Dindo criteria. Results: Four studies were included in the meta-analysis. The risk of all postoperative complications was not significantly different between IBDpatients exposed preoperatively to VDZ vs anti-TNFs (odds ratio [OR], 0.64; 95% confidence interval [CI], 0.21-1.88). In patients with ulcerative colitis (UC), the OR for complications was significantly lower in VDZ-exposed as opposed to anti-TNF-exposed patients (OR, 0.35; 95% CI, 0.14-0.85); the comparison was insignificant in Crohn's disease. There were no significant differences in the risk of infectious complications, surgical site infections, need for reoperation, or major surgical complications in patients exposed to VDZ vs anti-TNFs. There were no significant differences in outcomes when comparing patients exposed to VDZ with those not given biologic therapy. Conclusions: This meta-analysis did not detect an increased risk of postoperative complications with preoperative VDZ exposure; the risk of overall complications may be lower in UC patients in comparison with those with anti-TNF exposure. These results merit further verification in future studies.
Authors: N Horesh; M R Freund; Z Garoufalia; R Gefen; D Zhang; T Smith; S H Emile; S D Wexner Journal: Tech Coloproctol Date: 2022-09-29 Impact factor: 3.699
Authors: Jurij Hanzel; Ahmed Almradi; Alexandra C Istl; Mei Lucy Yang; Katherine A Fleshner; Claire E Parker; Leonardo Guizzetti; Christopher Ma; Siddharth Singh; Vipul Jairath Journal: Dig Dis Sci Date: 2021-02-26 Impact factor: 3.199