No effect of anti-TNF-α agents on the surgical stress response in patients with inflammatory bowel disease undergoing bowel resections: a prospective multi-center pilot study

Alaa El-Hussuna, Niels Qvist, Marie Strøm Zangenberg, Anne Langkilde, Volkert Siersma, Sara Hjort, Ismail Gögenur, Alaa El-Hussuna, Niels Qvist, Marie Strøm Zangenberg, Anne Langkilde, Volkert Siersma, Sara Hjort, Ismail Gögenur

Abstract

Background: TNF-α plays a role in angiogenesis and collagen synthesis, both essential in the wound healing process. There are concerns that pre-operative anti-TNF-α treatment may influence the surgical stress response and increase the risk of surgical complications. The aim of this study was to describe the surgical stress response in patients with inflammatory bowel disease (IBD) and to investigate whether the pre-operative administration of anti-tumor necrosis factor alpha (anti-TNF-α) agents modify the surgical stress response.

Methods: This was a prospective, multi-center cohort pilot study. The primary outcome was the change in concentration of immunological biomarkers of the surgical stress response (TNF-α, IL-6, and IL-10). Secondary outcome measures were changes in IL-8, IL-17A, C-reactive protein, white blood cells, cortisol, transferrin, ferritin, and D-Dimer in addition to 30 days' post-operative complications and length of post-operative stay in the hospital (LOS).

Results: Forty-six patients with IBD undergoing major abdominal surgery were included, and 18 received anti-TNF- α treatment pre-operatively. Peak increase of most of the immunological biomarkers occurred 6 hours after surgical incision. Then the concentration decreased after 24 h followed by a plateau at 48 h. After adjusting for confounders including detectable blood concentrations, no difference in the concentrations of immunological, endocrinological or haematological biomarkers of stress was found between anti-TNF-α treated and anti-TNF-α naïve patients. No increase in post-operative complications or LOS was noticed in patients who received anti-TNF-α treatment.

Conclusions: Anti-TNF-α did not affect surgical stress response in this pilot study. Withdrawal of anti-TNF-α drugs prior to surgical intervention in IBD patients might not be justified without measurement of drug concentration and drug antibodies.

Trial registration: Clinicaltrails.gov.: NCT01974869 .

Keywords: Anastomotic leak; Anti-TNF alpha; Crohn’s disease; Inflammatory bowel disease; Interleukins; Surgical stress response; Ulcerative colitis; Wound healing.

Conflict of interest statement

Competing interest

The authors declare that they have no competing interests.

Publisher’s Note

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Figures

Fig. 1
Fig. 1
Surgical stress response in 46 patients with inflammatory bowel disease who underwent surgical interventions as part of disease treatment. Main immunological biomarkers of stress are shown. The box shows the median and inter-quartile while the numbers above show the concentrations for outliers
Fig. 2
Fig. 2
Surgical stress response in 46 patients with inflammatory bowel disease who underwent surgical interventions as part of disease treatment. Immunological, endocrinological and hematological biomarkers of stress are shown. The box shows the median and inter-quartile while the numbers above show concentrations for the outliers
Fig. 3
Fig. 3
Surgical stress response in patients treated with anti-TNF-α agents versus anti-TNF-α naive. The figure shows only the main immunological biomarkers of stress. The box show the median and inter-quartile while the numbers above show the concentrations for outliers

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