Perioperative anti-TNF and anastomotic leak: trial evidence

What is known

• The topic is explicitly described as having conflicting results across studies addressing anti-TNF and postoperative/anastomotic complications. ¹
• Multiple studies report no increased early postoperative complication rate with perioperative anti-TNF, and early postoperative anti-TNF did not raise complications after abdominal surgery. ^2,3
• Conversely, infliximab use within 3 months of ileocolonic resection has been associated with adverse postoperative outcomes. ⁴
• The evidence base comprises case-control, single-/multicenter cohort, nationwide registry studies, and systematic reviews/meta-analyses, not randomized trials of anti-TNF timing. ^1,3,5

What is unknown / caveats

• Cohorts/pooled reviews showing no complication increase vs series linking pre-op infliximab to adverse outcomes
• Systematic reviews on the question reached differing conclusions
• No RCT randomizing perioperative anti-TNF exposure was retrieved. The question's premise of 'randomized trials' is not met by this literature
• Retrieved anti-TNF RCT evidence concerns postoperative recurrence prevention, not anastomotic leak
• The direction and magnitude of any anti-TNF effect on leak cannot be resolved from these observational, heterogeneous sources.

References

1. Myrelid P, Marti-Gallostra M, Ashraf S, Sunde ML, Tholin M, Oresland T, Lovegrove RE, Tøttrup A, Kjaer DW, George BD. Complications in surgery for Crohn's disease after preoperative antitumour necrosis factor therapy. Br J Surg. 2014;101(5):539-45. PMID: 24615529.

2. Shen B. Interventional inflammatory bowel disease: endoscopic therapy of complications of Crohn's disease. Gastroenterol Rep (Oxf). 2022;10:goac045. PMID: 36120488.

3. Maguire LH, Alavi K, Sudan R, Wise PE, Kaiser AM, Bordeianou L. Surgical Considerations in the Treatment of Small Bowel Crohn's Disease. J Gastrointest Surg. 2017;21(2):398-411. PMID: 27966058.

4. [No authors listed]. When should we add a diverting loop ileostomy to laparoscopic ileocolic resection for primary Crohn's disease?. Surg Endosc. 2021;35(6):2543-2557. PMID: 32468260.

5. [No authors listed]. Does preoperative enteral nutrition reduce the incidence of surgical complications in patients with Crohn's disease? A case-matched study. Colorectal Dis. 2020;22(5):554-561. PMID: 31782874.

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Draft, generated by the IBDology RAG and not yet clinician-reviewed. Answers are grounded in the retrieved literature listed above; a high faithfulness score means the answer matches its sources, not that the sources are correct.