1Department of Surgery, Slagelse Hospital, Slagelse, Denmark 2Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark 3Department of Surgery, Holbaek Hospital, University of Copenhagen, Copenhagen, Denmark 4Gastrounit, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
Dis Colon Rectum. 2013 Dec;56(12):1423-33. doi: 10.1097/DCR.0b013e3182a48505.
Patients with Crohn's disease treated with anti-tumor necrosis factor alpha agents may have an increased risk of surgical complications.
We assessed the effect of anti-tumor necrosis factor alpha on postoperative complications in patients with Crohn's disease undergoing abdominal surgery.
Studies were identified through electronic and manual searches.
Observational studies on patients with Crohn's disease undergoing laparoscopic or open abdominal surgery were included.
Anti-tumor necrosis factor alpha agents were administered within 3 months before surgery.
The primary outcome was anastomotic complications including overt dehiscence, intra-abdominal abscess, and enteric fistulas.
Fourteen studies on 679 patients in the intervention (anti-tumor necrosis factor alpha) group and 2363 controls were included. Random-effects meta-analysis found no difference in anastomotic complications between the 2 groups (7.6% versus 8.2%; risk ratio, 0.91; 95% CI, 0.56-1.48). There was clear heterogeneity between studies. In subgroup analyses, the anti-tumor necrosis factor alpha increased anastomotic complications in trials with a lower risk of bias, but not in the studies with a higher bias risk (risk ratio, 1.63; 95% CI, 1.03-2.60 and risk ratio, 0.17; 95% CI, 0.05-0.60). In the overall analysis and in studies with a lower bias risk, anti-tumor necrosis factor alpha agents increased the risk of nonanastomotic surgical complications, major medical complications, and minor medical complications.
Limitations of observations studies.
In studies with a low risk of bias, anti-tumor necrosis factor alpha agents increased the risk of anastomotic complications. Inadequate bias control may lead to an underestimated risk of anastomotic complications.
接受肿瘤坏死因子-α拮抗剂治疗的克罗恩病患者可能有更高的手术并发症风险。
我们评估了肿瘤坏死因子-α拮抗剂对接受腹部手术的克罗恩病患者术后并发症的影响。
通过电子和手动搜索确定研究。
纳入接受腹腔镜或开放性腹部手术的克罗恩病患者的观察性研究。
手术前 3 个月内给予肿瘤坏死因子-α拮抗剂。
主要结局为吻合口并发症，包括明显裂开、腹腔脓肿和肠瘘。
纳入了干预（肿瘤坏死因子-α拮抗剂）组 679 例患者和对照组 2363 例患者的 14 项研究。随机效应荟萃分析发现两组间吻合口并发症无差异（7.6%对 8.2%；风险比，0.91；95%CI，0.56-1.48）。研究间存在明显的异质性。在亚组分析中，肿瘤坏死因子-α拮抗剂增加了低偏倚风险试验中的吻合口并发症，但在高偏倚风险研究中没有增加（风险比，1.63；95%CI，1.03-2.60 和风险比，0.17；95%CI，0.05-0.60）。在整体分析和低偏倚风险研究中，肿瘤坏死因子-α拮抗剂增加了非吻合口手术并发症、主要医疗并发症和次要医疗并发症的风险。
观察性研究的局限性。
在低偏倚风险的研究中，肿瘤坏死因子-α拮抗剂增加了吻合口并发症的风险。偏倚控制不足可能导致对吻合口并发症风险的低估。
