Tumor Necrosis Factor Alpha Inhibitors Reduce Staged Surgery Rate and Prevent Postoperative Endoscopic Recurrence in Crohn's Disease Patients

Abstract

BACKGROUND: – The impact of preoperative tumor necrosis factor inhibitors on surgical outcomes in Crohn's disease remains controversial, while postoperative tumor necrosis factor inhibitors are known to prevent endoscopic recurrence. OBJECTIVE: – To evaluate whether preoperative tumor necrosis factor inhibitors reduce the need for staged surgery without increasing complications, and whether postoperative tumor necrosis factor inhibitors decrease endoscopic postoperative recurrence. DESIGN: – Retrospective observational cohort study. SETTING: – Inflammatory Bowel Disease Surgery Centre, Shanghai Tenth People's Hospital, China. PATIENTS: – A total of 202 Crohn's disease patients undergoing bowel resection (June 2019 - June 2024). Follow-up included 143 patients at 6 months and 116 at 1 year. INTERVENTIONS: – Preoperative tumor necrosis factor inhibitors (within 12 weeks before surgery) or postoperative tumor necrosis factor inhibitors (initiated more than 2 weeks after surgery) versus tumor necrosis factor inhibitor-naive patients. MAIN OUTCOME MEASURES: – Staged surgery rate, complications, hospital stay, and endoscopic postoperative recurrence (Rutgeerts score ≥ i2) at 6 months and 1 year. RESULTS: – Preoperative tumor necrosis factor inhibitors significantly reduced staged surgery versus naive patients (39.73% vs. 60.47%; odds ratio 0.43, P = 0.01). No differences were found in hospital stay, 1-month complications (13.70% vs. 13.95%), or 1-year reoperation rates (9.52% vs. 4.05%). Postoperative tumor necrosis factor inhibitors significantly lowered endoscopic recurrence at 6 months (18.67% vs. 35.29%; odds ratio 0.42, p = 0.03) and 1 year (22.41% vs. 39.66%; odds ratio 0.44, p = 0.05). One-year reoperation complication rates were similar (3.45% vs. 8.62%, p = 0.44). LIMITATIONS: – Retrospective design; selection bias; single-center study. CONCLUSIONS: – Preoperative tumor necrosis factor inhibitors reduce the need for staged surgery without increasing complications. Postoperative tumor necrosis factor inhibitors effectively reduce endoscopic recurrence at 6 months and 1 year. Perioperative use appears safe and beneficial for Crohn's disease patients requiring surgery. See Video Abstract.