Review Article

Journal of Gastrointestinal Surgery

, Volume 18, Issue 6, pp 1216-1224

The Impact of Peri-operative Anti-TNF Treatment on Anastomosis-Related Complications in Crohn’s Disease Patients. A Critical Review

  • Ioannis PapaconstantinouAffiliated withSecond Department of Surgery, Aretaieion Hospital, Medical School, University of Athens
  • , Christos ZeglinasAffiliated withDepartment of Gastroenterology, Tzaneio General Hospital Email author 
  • , Maria GazouliAffiliated withMolecular Carcinogenesis Group, Laboratory of Histology and Embryology, School of Medicine, University of Athens
  • , Konstantinos NastosAffiliated withSecond Department of Surgery, Aretaieion Hospital, Medical School, University of Athens
  • , Anneza YiallourouAffiliated withSecond Department of Surgery, Aretaieion Hospital, Medical School, University of Athens
  • , Apostolos PapaloisAffiliated withExperimental-Research Unit, ELPEN-Pharmaceuticals Co. Inc
  • , Charalambos TzathasAffiliated withDepartment of Gastroenterology, Tzaneio General Hospital

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Abstract

Introduction

Tumor necrosis factor (TNF)α is a cytokine exerting pleiotropic effects on critical cell functions and, most importantly, is the main regulator of pro-inflammatory cytokine production and a key player in the pathophysiology of numerous autoimmune diseases, including Crohn’s disease.

Methods

TNFα became a therapeutic target and TNFα blocking agents are currently used in the treatment of inflammatory diseases. Beyond the therapeutic benefits deriving from TNFα neutralization, amendments in the cellular functions of the immune system may as well induce potent immunosuppressive effects. An attenuated immune response may compromise the intestinal healing ability, thus leading to weaker anastomosis and increased risk of anastomotic leak and septic complications.

Results

This hypothesis raises great concerns about the safety of perioperative administration of anti-TNF and has been the endpoint of numerous studies.

Conclusion

The aim of this review is to critically evaluate the evidence regarding the role of TNFα in anastomosis related complications after abdominal surgery in Crohn’s disease patients.

Keywords

TNFα Wound Healing Intestinal anastomoses Postoperative complications