Skip to main content
SpringerLink
Log in

Impact des traitements de la maladie de Crohn sur la morbidité chirurgicale

Medical treatments for Crohn’s disease and postoperative outcome

  • Dossier Thématique / Thematic File
  • Published:
Côlon & Rectum

Résumé

Actuellement, 60 à 70 % des patients ayant une maladie de Crohn (MC) ont une intervention chirurgicale au cours de l’évolution de leur maladie. Les deux principaux inconvénients du traitement chirurgical de la MC sont, d’une part, le risque de récidive postopératoire de la maladie qui concerne près de deux tiers des malades et, d’autre part, le risque de complications postopératoires qui peut survenir chez près de 40 % des patients. La chirurgie peut être envisagée à différents stades de la maladie, mais souvent l’option chirurgicale est proposée devant l’échec d’une ou de plusieurs lignes de traitements médicaux. Au cours des 20 dernières années, de nombreuses études pour la majorité rétrospectives ont tenté d’identifier les facteurs de risque de complications postopératoires après chirurgie d’exérèse pour MC et notamment l’influence des traitements médicaux administrés dans la période préopératoire. L’analyse de l’effet des traitements de la MC sur le risque de complication postopératoire est d’autant plus difficile que l’échec de ces thérapeutiques, qui conduit à poser l’indication chirurgicale, reflète également la sévérité de la maladie. Cette revue permet de faire une mise au point sur l’influence des différents traitements de la MC sur le risque de complications postopératoires ainsi que les mesures qui peuvent être proposées pour limiter l’effet délétère de ces traitements.

Abstract

Up to 70% of Crohn’s disease patients have surgery at some point during the course of their disease. Limitations of surgical therapy for Crohn’s disease include the risk of postoperative recurrence that can affect more than half the patients and the risk of postoperative morbidity that can occur in up to 40% of the patients. Surgery can be discussed at different stages of Crohn’s disease but in most cases, resection is proposed after failure of one or several lines of medical treatment. In the last two decades, numerous retrospective studies have been conducted and aimed at identifying risk factors of postoperative complications after surgery for Crohn’s disease including the effect of previous medical treatment. Analysis of the influence of these treatments on the risk of postoperative morbidity is difficult as the failure of medical therapy likely reflects the severity of the disease. The aim of this review was to better define the influence of the different therapies targeting Crohn’s disease on the risk of postoperativemorbidity and the measures that can be proposed to manage this risk.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Références

  1. Cosnes J, Gower-Rousseau C, Seksik P, Cortot A (2011) Epidemiology and natural history of inflammatory bowel diseases. Gastroenterology 140:1785–94

    Article  PubMed  Google Scholar 

  2. Shental O, Tulchinsky H, Greenberg R, et al (2012) Positive histological inflammatory margins are associated with increased risk for intra-abdominal septic complications in patients undergoing ileocolic resection for Crohn’s disease. Dis Colon Rectum 55:1125–30

    Article  PubMed  Google Scholar 

  3. Alves A, Panis Y, Bouhnik Y, et al (2007) Risk factors for intraabdominal septic complications after a first ileocecal resection for Crohn’s disease: a multivariate analysis in 161 consecutive patients. Dis Colon Rectum 50:331–6

    Article  PubMed  Google Scholar 

  4. Yamamoto T, Allan RN, Keighley MR (2000) Risk factors for intra-abdominal sepsis after surgery in Crohn’s disease. Dis Colon Rectum 43:1141–5

    Article  CAS  PubMed  Google Scholar 

  5. De Cruz P, Kamm MA, Hamilton AL, et al (2015) Efficacy of thiopurines and adalimumab in preventing Crohn’s disease recurrence in high-risk patients — a POCER study analysis. Aliment Pharmacol Ther 42:867–79

    Article  PubMed  Google Scholar 

  6. Regueiro M, Kip KE, Baidoo L, et al (2014) Postoperative therapy with infliximab prevents long-term Crohn’s disease recurrence. Clin Gastroenterol Hepatol 12:1494–502

    Article  CAS  PubMed  Google Scholar 

  7. Yoshida K, Fukunaga K, Ikeuchi H, et al (2012) Scheduled infliximab monotherapy to prevent recurrence of Crohn’s disease following ileocolic or ileal resection: a 3-year prospective randomized open trial. Inflamm Bowel Dis 18:1617–23

    Article  PubMed  Google Scholar 

  8. Zerbib P, Koriche D, Truant S, et al (2010) Preoperative management is associated with low rate of postoperative morbidity in penetrating Crohn’s disease. Aliment Pharmacol Ther 32:459–65

    Article  CAS  PubMed  Google Scholar 

  9. Jacobson S (2012) Early postoperative complications in patients with Crohn’s disease given and not given preoperative total parenteral nutrition. Scand J Gastroenterol 47:170–7

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Milsom JW, Hammerhofer KA, Böhm B, et al (2001) Prospective, randomized trial comparing laparoscopic vs. conventional surgery for refractory ileocolic Crohn’s disease. Dis Colon Rectum 44:1–8

    Article  CAS  PubMed  Google Scholar 

  11. Maartense S, Dunker MS, Slors JFM, et al (2006) Laparoscopicassisted versus open ileocolic resection for Crohn’s disease: a randomized trial. Ann Surg 243:143–9

    Article  PubMed  PubMed Central  Google Scholar 

  12. Kanazawa A, Yamana T, Okamoto K, Sahara R (2012) Risk factors for postoperative intra-abdominal septic complications after bowel resection in patients with Crohn’s disease. Dis Colon Rectum 55:957–62

    Article  PubMed  Google Scholar 

  13. Brouquet A, Maggiori L, Zerbib P, et al (2017) Anti-TNF therapy is associated with an increased risk of postoperative morbidity after surgery for ileocolonic Crohn disease. Ann Surg (sous presse)

    Google Scholar 

  14. Williams C, Panaccione R, Ghosh S, Rioux K (2011) Optimizing clinical use of mesalazine (5-aminosalicylic acid) in inflammatory bowel disease. Ther Adv Gastroenterol 4:237–48

    Article  CAS  Google Scholar 

  15. Doherty G, Bennett G, Patil S, et al (2009) Interventions for prevention of postoperative recurrence of Crohn’s disease. Cochrane Database Syst Rev CD006873

    Google Scholar 

  16. Patel H, Barr A, Jeejeebhoy KN (2009) Renal effects of longterm treatment with 5-aminosalicylic acid. Can J Gastroenterol 23:170–6

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Myrelid P, Olaison G, Sjödahl R, et al (2009) Thiopurine therapy is associated with postoperative intra-abdominal septic complications in abdominal surgery for Crohn’s disease. Dis Colon Rectum 52:1387–94

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  19. Kumar A, Auron M, Aneja A, et al (2011) Inflammatory bowel disease: perioperative pharmacological considerations. Mayo Clin Proc 86:748–57

    Article  PubMed  PubMed Central  Google Scholar 

  20. Stein RB, Hanauer SB (2000) Comparative tolerability of treatments for inflammatory bowel disease. Drug Saf 23:429–48

    Article  CAS  PubMed  Google Scholar 

  21. Subramanian V, Saxena S, Kang JY, Pollok RCG (2008) Preoperative steroid use and risk of postoperative complications in patients with inflammatory bowel disease undergoing abdominal surgery. Am J Gastroenterol 103:2373–81

    Article  PubMed  Google Scholar 

  22. Aberra FN, Lewis JD, Hass D, et al (2003) Corticosteroids and immunomodulators: postoperative infectious complication risk in inflammatory bowel disease patients. Gastroenterology 125:320–7

    Article  CAS  PubMed  Google Scholar 

  23. Mahadevan U, Loftus EV, Tremaine WJ, et al (2002) Azathioprine or 6-mercaptopurine before colectomy for ulcerative colitis is not associated with increased postoperative complications. Inflamm Bowel Dis 8:311–6

    Article  PubMed  Google Scholar 

  24. Heuschen UA, Hinz U, Allemeyer EH, et al (2002) Risk factors for ileoanal J pouch-related septic complications in ulcerative colitis and familial adenomatous polyposis. Ann Surg 235:207–16

    Article  PubMed  PubMed Central  Google Scholar 

  25. Ziv Y, Fazio VW, Church JM, et al (1996) Stapled ileal pouch anal anastomoses are safer than handsewn anastomoses in patients with ulcerative colitis. Am J Surg 171:320–3

    Article  CAS  PubMed  Google Scholar 

  26. Pearson DC, May GR, Fick G, Sutherland LR (2000) Azathioprine for maintaining remission of Crohn’s disease. Cochrane Database Syst Rev CD000067

    Google Scholar 

  27. Schroll S, Sarlette A, Ahrens K, et al (2005) Effects of azathioprine and its metabolites on repair mechanisms of the intestinal epithelium in vitro. Regul Pept 131:1–11

    Article  CAS  PubMed  Google Scholar 

  28. Karukonda SR, Flynn TC, Boh EE, et al (2000) The effects of drugs on wound healing-part II. Specific classes of drugs and their effect on healing wounds. Int J Dermatol 39:321–33.

    Article  CAS  PubMed  Google Scholar 

  29. Tay GS, Binion DG, Eastwood D, OttersonMF (2003) Multivariate analysis suggests improved perioperative outcome in Crohn’s disease patients receiving immunomodulator therapy after segmental resection and/or strictureplasty. Surgery 134:565–72

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  31. Sands BE, Anderson FH, Bernstein CN, et al (2004) Infliximab maintenance therapy for fistulizing Crohn’s disease. N Engl J Med 350:876–85

    Article  CAS  PubMed  Google Scholar 

  32. Lee RH, Efron DT, Tantry U, et al (2000) Inhibition of tumor necrosis factor-alpha attenuates wound breaking strength in rats. Wound Repair Regen 8:547–53

    Article  CAS  PubMed  Google Scholar 

  33. Albina JE, Mastrofrancesco B, Vessella JA, et al (2001) HIF-1 expression in healing wounds: HIF-1alpha induction in primary inflammatory cells by TNF-alpha. Am J Physiol Cell Physiol 281:C1971–C7

    CAS  PubMed  Google Scholar 

  34. Kunitake H, Hodin R, Shellito PC, et al (2008) 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 12:1730–6

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  36. Billioud V, Ford AC, Tedesco ED, et al (2013) Preoperative use of anti-TNF therapy and postoperative complications in inflammatory bowel diseases: a meta-analysis. J Crohns Colitis 7:853–67

    Article  PubMed  Google Scholar 

  37. Narula N, Charleton D, Marshall JK (2013) Meta-analysis: perioperative anti-TNFα treatment and postoperative complications in patients with inflammatory bowel disease. Aliment Pharmacol Ther 37:1057–64

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  PubMed Central  Google Scholar 

  39. Moćko P, Kawalec P, Smela-Lipińska B, Pilc A (2016) Effectiveness and safety of vedolizumab for treatment of Crohn’s disease: a systematic review and meta-analysis. Arch Med Sci 12:1088–96

    Article  PubMed  PubMed Central  Google Scholar 

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

    Article  PubMed  Google Scholar 

  41. Sharma A, Chinn BT (2013) Preoperative optimization of Crohn disease. Clin Colon Rectal Surg 26:75–9

    Article  PubMed  PubMed Central  Google Scholar 

  42. Rosandich PA, Kelley JT, Conn DL (2004) Perioperative management of patients with rheumatoid arthritis in the era of biologic response modifiers. Curr Opin Rheumatol 16:192–8

    Article  CAS  PubMed  Google Scholar 

  43. Beaupel N, Brouquet A, Abdalla S, et al (2017) Preoperative oral polymeric diet enriched with transforming growth factor-beta 2 (Modulen®) could decrease postoperative morbidity after surgery for complicated ileocolonic Crohn’s disease. Scand J Gastroenterol 52:5–10

    Article  CAS  PubMed  Google Scholar 

  44. Trebble TM, Arden NK, Wootton SA, et al (2004) Fish oil and antioxidants alter the composition and function of circulating mononuclear cells in Crohn disease. Am J Clin Nutr 80:1137–44

    CAS  PubMed  Google Scholar 

  45. Mege D, Bege T, Beyer-Berjot L, et al (2015) Does faecal diversion prevent morbidity after ileocecal resection for Crohn’s disease? Retrospective series of 80 cases. ANZ J Surg [in press]

    Google Scholar 

  46. Brouquet A, Blanc B, Bretagnol F, et al (2010) Surgery for intestinal Crohn’s disease recurrence. Surgery 148:936–46

    Article  PubMed  Google Scholar 

  47. Mège D, Figueiredo MN, Manceau G, et al (2016) Three-stage laparoscopic ileal pouch-anal anastomosis is the best approach for high-risk patients with inflammatory bowel disease: an analysis of 185 consecutive patients. J Crohns Colitis 10:898–904

    Article  PubMed  Google Scholar 

  48. Duchesne JC, Wang YZ, Weintraub SL, et al (2002) Stoma complications: a multivariate analysis. Am Surg 68:961–6

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Service de chirurgie digestive et oncologique, hôpital Bicêtre, AP–HP, 78, rue du Général-Leclerc, F-94270, Le Kremlin-Bicêtre, France

    S. Abdalla & A. Brouquet

  2. Unité Inserm U1169, faculté de médecine Paris-Sud, F-94270, Le Kremlin-Bicêtre, France

    S. Abdalla & A. Brouquet

Authors
  1. S. Abdalla
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Brouquet
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Brouquet.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Abdalla, S., Brouquet, A. Impact des traitements de la maladie de Crohn sur la morbidité chirurgicale. Colon Rectum 11, 140–146 (2017). https://doi.org/10.1007/s11725-017-0721-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11725-017-0721-3

Mots clés

Keywords

Search

Navigation