Surgery for Inflammatory Bowel Disease in the Era of Biologic Therapy: A Multicenter Experience from Romania

Abstract

Background and Objectives: Biologic therapy has fundamentally changed the opportunity of medical treatment to induce and maintain remission in inflammatory bowel disease (IBD). Nevertheless, the rate of surgery is still at a very high rate, profoundly affecting the quality of life. We aimed to analyze surgical cases at three major IBD units in order to identify the main risk factors and the impact of biologic therapy on pre- and postsurgical outcomes. Material and Methods: This was a multicenter retrospective cohort study that included 56 patients with IBD-related surgical interventions from 3 tertiary care hospitals in Bucharest, Romania. The study was conducted between January 2017 and June 2021. All data were retrospectively collected from the medical records of the patients and included the age at diagnosis, age at the time of surgery, IBD type and phenotype, biologic therapy before or/and after surgery, timing of biologic therapy initiation, extraintestinal manifestations, type of surgery (elective/emergency), early and long-term postoperative complications and a history of smoking. Results: A low rate of surgical interventions was noted in our cohort (10.3%), but half of these occurred in the first year after the IBD diagnosis. A total of 48% of the surgical interventions had been performed in an emergency setting, which seemed to be associated with a high rate of long-term postoperative complications. We found no statistically significant differences between IBD patients undergoing treatments with biologics before surgery and patients who did not receive biologics before the surgical intervention in terms of the IBD phenotype, type of surgery and postoperative complications. Conclusion: Our study showed that biologics initiated before the surgical intervention did not influence the postoperative complications. Moreover, we demonstrated that patients with Crohn’s disease and no biologics were the most susceptible to having to undergo surgery. Conclusion: In conclusion, the management of patients with IBD requires a multidisciplinary approach that considers an unpredictable evolution.

Inflammatory bowel diseases: Transformation of representations. A review

“…(2022 г.) в исследовании выявили достаточно низкий уровень хирургических вмешательств, который составил 10,4%, наблюдая всех пациентов с ВЗК в период с 2017 по 2021 г., проходивших лечение в клинике по поводу ВЗК (n=540) [102]. Авторы исследования сообщают, что обычной практикой их клиники было предпочтение раннего начала биологической терапии у пациентов с бóльшей распространенностью и эндоскопической активностью ВЗК, что предполагает потенциально более агрессивное течение.…”

Combination biologic therapy in pediatric inflammatory bowel disease: Safety and efficacy over a minimum 12‐month follow‐up period

“…Diagnosis at a young age is an unfavorable prognostic factor for the development of IBD and surgical interventions. 8,9 According to the available literature in the population of adult patients diagnosed with IBD, early introduction of biological therapy can improve the prognosis of the disease by faster remission, reduction of corticosteroid use, and delay in the need for surgery. 10,11 The most frequently used biological drugs in the treatment of moderate and severe IBD in children are anti-TNF (tumor necrosis factor) agents.…”