Skip to main content
SpringerLink
Log in

Managing Biologics Perioperatively

  • Chapter
  • First Online:
Mastery of IBD Surgery

Abstract

Approximately 60% of patients with Crohn’s disease (CD) [1, 2] and 30% with ulcerative colitis (UC) [3] will undergo a major abdominal operation during their disease course. Since the advent of biologic therapy with the Federal Drug Administration (FDA) approval of infliximab in 1998, biologics have gained an important foothold in the treatment of inflammatory bowel disease (IBD) [4]. Thus, an ever-increasing number of patients are undergoing surgical consultation at the time of biologic exposure. At that time, patients often have a loss of response to biologic therapy, with poor relief of symptoms, increasing disease severity, worsening nutrition, and the addition of concurrent immunomodulators and/or corticosteroids in an attempt to bridge them to surgery. Therefore, whether it’s the biologic agents themselves or increased disease severity that increases postoperative morbidity remains difficult to discern. Regardless, it is imperative that surgeons have an increased understanding of the perioperative optimization of biologics in order to more closely work with both their patients and gastroenterologists to optimize outcomes (Table 7.1).

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Cosnes J, Gower-Rousseau C, Seksik P, Cortot A. Epidemiology and natural history of inflammatory bowel diseases. Gastroenterology 2011;140(6):1785–1794.

    Article  Google Scholar 

  2. Peyrin-Biroulet L, Loftus EV Jr, Colombel JF, Sandborn WJ. The natural history of adult Crohn’s disease in population-based cohorts. Am J Gastroenterol. 2010;105(2):289–97.

    Article  Google Scholar 

  3. Feuerstein JD, Cheifetz AS. Ulcerative colitis: epidemiology, diagnosis, and management. Mayo Clin Proc. 2014;89(11):1553–63.

    Article  Google Scholar 

  4. Cote-Daigneault J, Bouin M, Lahaie R, Colombel JF, Poitras P. Biologics in inflammatory bowel disease: what are the data? United European Gastroenterol J. 2015;3(5):419–28.

    Article  CAS  Google Scholar 

  5. Bafford AC, Powers S, Ha C, et al. Immunosuppressive therapy does not increase operative morbidity in patients with Crohn’s disease. J Clin Gastroenterol. 2013;47(6):491–5.

    Article  Google Scholar 

  6. Canedo J, Lee SH, Pinto R, Murad-Regadas S, Rosen L, Wexner SD. Surgical resection in Crohn’s disease: is immunosuppressive medication associated with higher postoperative infection rates? Color Dis. 2011;13(11):1294–8.

    Article  CAS  Google Scholar 

  7. Colombel JF, Loftus EV Jr, Tremaine WJ, et al. The safety profile of infliximab in patients with Crohn’s disease: the Mayo clinic experience in 500 patients. Gastroenterology. 2004;126(1):19–31.

    Article  CAS  Google Scholar 

  8. Fumery M, Seksik P, Auzolle C, et al. Postoperative complications after ileocecal resection in Crohn’s disease: a prospective study from the REMIND group. Am J Gastroenterol. 2017;112(2):337–45.

    Article  Google Scholar 

  9. Indar AA, Young-Fadok TM, Heppell J, Efron JE. Effect of perioperative immunosuppressive medication on early outcome in Crohn’s disease patients. World J Surg. 2009;33(5):1049–52.

    Article  Google Scholar 

  10. Kasparek MS, Bruckmeier A, Beigel F, et al. Infliximab does not affect postoperative complication rates in Crohn’s patients undergoing abdominal surgery. Inflamm Bowel Dis. 2012;18(7):1207–13.

    Article  Google Scholar 

  11. Kotze PG, Magro DO, Martinez CAR, et al. Adalimumab and postoperative complications of elective intestinal resections in Crohn’s disease: a propensity score case-matched study. Color Dis. 2017; https://doi.org/10.1111/codi.13929.

    Article  Google Scholar 

  12. Kotze PG, Saab MP, Saab B, et al. Tumor necrosis factor alpha inhibitors did not influence postoperative morbidity after elective surgical resections in Crohn’s disease. Dig Dis Sci. 2017;62(2):456–64.

    Article  CAS  Google Scholar 

  13. Krane MK, Allaix ME, Zoccali M, et al. Preoperative infliximab therapy does not increase morbidity and mortality after laparoscopic resection for inflammatory bowel disease. Dis Colon Rectum. 2013;56(4):449–57.

    Article  Google Scholar 

  14. Kunitake H, Hodin R, Shellito PC, Sands BE, Korzenik J, Bordeianou L. Perioperative treatment with infliximab in patients with Crohn’s disease and ulcerative colitis is not associated with an increased rate of postoperative complications. J Gastrointest Surg. 2008;12(10):1730–6.

    Article  Google Scholar 

  15. Marchal L, D’Haens G, Van Assche G, et al. The risk of post-operative complications associated with infliximab therapy for Crohn’s disease: a controlled cohort study. Aliment Pharmacol Ther. 2004;19(7):749–54.

    Article  CAS  Google Scholar 

  16. Mascarenhas C, Nunoo R, Asgeirsson T, et al. Outcomes of ileocolic resection and right hemicolectomies for Crohn’s patients in comparison with non-Crohn’s patients and the impact of perioperative immunosuppressive therapy with biologics and steroids on inpatient complications. Am J Surg. 2012;203(3):375–8.. discussion 378

    Article  Google Scholar 

  17. Myrelid P, Marti-Gallostra M, Ashraf S, et al. Complications in surgery for Crohn’s disease after preoperative antitumour necrosis factor therapy. Br J Surg. 2014;101(5):539–45.

    Article  CAS  Google Scholar 

  18. Nasir BS, Dozois EJ, Cima RR, et al. Perioperative anti-tumor necrosis factor therapy does not increase the rate of early postoperative complications in Crohn’s disease. J Gastrointest Surg. 2010;14(12):1859–65; discussion 1865-1856

    Article  Google Scholar 

  19. Norgard BM, Nielsen J, Qvist N, Gradel KO, de Muckadell OB, Kjeldsen J. Pre-operative use of anti-TNF-alpha agents and the risk of post-operative complications in patients with Crohn’s disease–a nationwide cohort study. Aliment Pharmacol Ther. 2013;37(2):214–24.

    Article  CAS  Google Scholar 

  20. Rizzo G, Armuzzi A, Pugliese D, et al. Anti-TNF-alpha therapies do not increase early postoperative complications in patients with inflammatory bowel disease. An Italian single-center experience. Int J Color Dis. 2011;26(11):1435–44.

    Article  Google Scholar 

  21. Rosenfeld G, Qian H, Bressler B. The risks of post-operative complications following pre-operative infliximab therapy for Crohn’s disease in patients undergoing abdominal surgery: a systematic review and meta-analysis. J Crohns Colitis. 2013;7(11):868–77.

    Article  Google Scholar 

  22. Waterman M, Xu W, Dinani A, et al. Preoperative biological therapy and short-term outcomes of abdominal surgery in patients with inflammatory bowel disease. Gut. 2013;62(3):387–94.

    Article  Google Scholar 

  23. Yamamoto T, Spinelli A, Suzuki Y, et al. Risk factors for complications after ileocolonic resection for Crohn’s disease with a major focus on the impact of preoperative immunosuppressive and biologic therapy: a retrospective international multicentre study. United European Gastroenterol J. 2016;4(6):784–93.

    Article  Google Scholar 

  24. Appau KA, Fazio VW, Shen B, et al. Use of infliximab within 3 months of ileocolonic resection is associated with adverse postoperative outcomes in Crohn’s patients. J Gastrointest Surg. 2008;12(10):1738–44.

    Article  Google Scholar 

  25. Billioud V, Ford AC, Tedesco ED, Colombel JF, Roblin X, Peyrin-Biroulet L. Preoperative use of anti-TNF therapy and postoperative complications in inflammatory bowel diseases: a meta-analysis. J Crohns Colitis. 2013;7(11):853–67.

    Article  Google Scholar 

  26. Brouquet A, Maggiori L, Zerbib P, et al. Anti-TNF therapy is associated with an increased risk of postoperative morbidity after surgery for ileocolonic Crohn disease: results of a prospective nationwide cohort. Ann Surg. 2018;267(2):221–8.

    Article  Google Scholar 

  27. de Buck van Overstraeten A, Eshuis EJ, Vermeire S, et al. Short- and medium-term outcomes following primary ileocaecal resection for Crohn’s disease in two specialist centres. Br J Surg. 2017;104(12):1713–22.

    Article  CAS  Google Scholar 

  28. El-Hussuna A, Krag A, Olaison G, Bendtsen F, Gluud LL. The effect of anti-tumor necrosis factor alpha agents on postoperative anastomotic complications in Crohn’s disease: a systematic review. Dis Colon Rectum. 2013;56(12):1423–33.

    Article  Google Scholar 

  29. Kopylov U, Ben-Horin S, Zmora O, Eliakim R, Katz LH. Anti-tumor necrosis factor and postoperative complications in Crohn’s disease: systematic review and meta-analysis. Inflamm Bowel Dis. 2012;18(12):2404–13.

    Article  Google Scholar 

  30. Lau C, Dubinsky M, Melmed G, et al. The impact of preoperative serum anti-TNFalpha therapy levels on early postoperative outcomes in inflammatory bowel disease surgery. Ann Surg. 2015;261(3):487–96.

    Article  Google Scholar 

  31. Morar PS, Hodgkinson JD, Thalayasingam S, et al. Determining predictors for intra-abdominal septic complications following ileocolonic resection for Crohn’s disease-considerations in pre-operative and peri-operative optimisation techniques to improve outcome. J Crohns Colitis. 2015;9(6):483–91.

    Article  Google Scholar 

  32. Narula N, Charleton D, Marshall JK. Meta-analysis: peri-operative anti-TNFalpha treatment and post-operative complications in patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2013;37(11):1057–64.

    Article  CAS  Google Scholar 

  33. Serradori T, Germain A, Scherrer ML, et al. The effect of immune therapy on surgical site infection following Crohn’s Disease resection. Br J Surg. 2013;100(8):1089–93.

    Article  CAS  Google Scholar 

  34. Syed A, Cross RK, Flasar MH. Anti-tumor necrosis factor therapy is associated with infections after abdominal surgery in Crohn’s disease patients. Am J Gastroenterol. 2013;108(4):583–93.

    Article  CAS  Google Scholar 

  35. Yang ZP, Hong L, Wu Q, Wu KC, Fan DM. Preoperative infliximab use and postoperative complications in Crohn’s disease: a systematic review and meta-analysis. Int J Surg. 2014;12(3):224–30.

    Article  Google Scholar 

  36. Bregnbak D, Mortensen C, Bendtsen F. Infliximab and complications after colectomy in patients with ulcerative colitis. J Crohns Colitis. 2012;6(3):281–6.

    Article  Google Scholar 

  37. Eshuis EJ, Al Saady RL, Stokkers PC, Ponsioen CY, Tanis PJ, Bemelman WA. Previous infliximab therapy and postoperative complications after proctocolectomy with ileum pouch anal anastomosis. J Crohns Colitis. 2013;7(2):142–9.

    Article  Google Scholar 

  38. Ferrante M, D’Hoore A, Vermeire S, et al. Corticosteroids but not infliximab increase short-term postoperative infectious complications in patients with ulcerative colitis. Inflamm Bowel Dis. 2009;15(7):1062–70.

    Article  CAS  Google Scholar 

  39. Gainsbury ML, Chu DI, Howard LA, et al. Preoperative infliximab is not associated with an increased risk of short-term postoperative complications after restorative proctocolectomy and ileal pouch-anal anastomosis. J Gastrointest Surg. 2011;15(3):397–403.

    Article  Google Scholar 

  40. Mor IJ, Vogel JD, da Luz Moreira A, Shen B, Hammel J, Remzi FH. Infliximab in ulcerative colitis is associated with an increased risk of postoperative complications after restorative proctocolectomy. Dis Colon Rectum. 2008;51(8):1202–7; discussion 1207-1210

    Article  CAS  Google Scholar 

  41. Selvasekar CR, Cima RR, Larson DW, et al. Effect of infliximab on short-term complications in patients undergoing operation for chronic ulcerative colitis. J Am Coll Surg. 2007;204(5):956–62; discussion 962-953

    Article  Google Scholar 

  42. Yang Z, Wu Q, Wang F, Wu K, Fan D. Meta-analysis: effect of preoperative infliximab use on early postoperative complications in patients with ulcerative colitis undergoing abdominal surgery. Aliment Pharmacol Ther. 2012;36(10):922–8.

    Article  CAS  Google Scholar 

  43. Lightner AL, Raffals LE, Mathis KL, et al. Postoperative outcomes in vedolizumab-treated patients undergoing abdominal operations for inflammatory bowel disease. J Crohns Colitis. 2017;11(2):185–90.

    Article  Google Scholar 

  44. Lightner AL, Mathis KL, Tse CS, et al. Postoperative outcomes in vedolizumab-treated patients undergoing major abdominal operations for inflammatory bowel disease: retrospective multicenter cohort study. Inflamm Bowel Dis. 2018;24(4):871–6.

    Article  Google Scholar 

  45. Yamada A, Komaki Y, Patel N, et al. Risk of postoperative complications among inflammatory bowel disease patients treated preoperatively with vedolizumab. Am J Gastroenterol. 2017;112(9):1423–9.

    Article  CAS  Google Scholar 

  46. Ferrante M, de Buck van Overstraeten A, Schils N, et al. Perioperative use of vedolizumab is not associated with postoperative infectious complications in patients with ulcerative colitis undergoing colectomy. J Crohns Colitis. 2017;11(11):1353–61.

    Article  Google Scholar 

  47. Lightner AL, McKenna NP, Tse CS, Raffals LE, Loftus EVJ, Mathis KL. Postoperative outcomes in vedolizumab-treated Crohn’s disease patients undergoing major abdominal operations. Aliment Pharmacol Ther. 2018;47(5):573–80.

    Article  CAS  Google Scholar 

  48. Lightner AL, McKenna NP, Moncrief S, Pemberton JH, Raffals LE, Mathis KL. Surgical outcomes in vedolizumab-treated patients with ulcerative colitis. Inflamm Bowel Dis. 2017;23(12):2197–201.

    Article  Google Scholar 

  49. Lightner AL, McKenna NP, Tse CS, et al. Postoperative outcomes in ustekinumab-treated patients undergoing abdominal operations for Crohn’s disease. J Crohns Colitis. 2018;12(4):402–7.

    Article  Google Scholar 

  50. Lopez N, Zaghiyan K, Melmed G, McGovern D, Jain A, Targan S, Fleshner P, Landers C. P394 Preoperative serum vedolizumab levels do not predict postoperative outcomes in inflammatory bowel disease (IBD). JCC. 2018;12(Suppl_1):S303–4.

    Google Scholar 

  51. Regueiro M, Velayos F, Greer JB, et al. American gastroenterological association institute technical review on the management of Crohn’s disease after surgical resection. Gastroenterology. 2017;152(1):277–295 e273.

    Article  Google Scholar 

  52. Colombel JF, Loftus EV Jr, Tremaine WJ, et al. Early postoperative complications are not increased in patients with Crohn’s disease treated perioperatively with infliximab or immunosuppressive therapy. Am J Gastroenterol. 2004;99(5):878–83.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Associate Professor of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA

    Amy L. Lightner

Authors
  1. Amy L. Lightner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Amy L. Lightner .

Editor information

Editors and Affiliations

  1. Colon and Rectal Surgery, University of Chicago, Chicago, IL, USA

    Neil Hyman

  2. Section of Colon and Rectal Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Phillip Fleshner

  3. Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Scott Strong

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Lightner, A.L. (2019). Managing Biologics Perioperatively. In: Hyman, N., Fleshner, P., Strong, S. (eds) Mastery of IBD Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-16755-4_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-16755-4_7

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-16754-7

  • Online ISBN: 978-3-030-16755-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation